Sebastian Faro

A Tribute to Abe Mickal, 1912&#x2013;2001

An Important Resource for the Physician
Committed to Caring for Women

Hepatitis A Vaccine

David E. Soper

The Germ Theory of Disease or&#8220;Where Have All the Cultures Gone&#63;&#8221;

Objective: To compare two protocols for intrapartum antibiotic prophylaxis (IAP) against neonatal group B streptococcal (GBS) sepsis, with respect to staff compliance, in a prospective cohort study in the obstetric units of a community hospital (A) and a university teaching hospital (B).Methods: Cohorts comprised about 500 women attending antenatal clinics at each hospital (total 1096). Women identified as GBS carriers at 26–32 weeks'gestation and those who had intrapartum clinical risk factors (CRF) were eligible for IAP. Compliance was defined as the proportion of women eligible for IAP who received it according to protocol–as determined by audit of case records–and compared between hospitals and according to indication.Results: Overall, 39% of women were eligible for IAP. Indications were GBS carriage alone (21%), CRF alone (13% ) and both (5% ). Compliance was similar for GBS carriers at both hospitals: 78% at Hospital A and 76% at Hospital B. However, because of the poor predictive value of screening before 32 weeks, only 65%of intrapartum GBS carriers actually received IAP. For women with CRF only, compliance was significantly lower at Hospital B than Hospital A (56 vs. 75%; p= 0.03).Conclusions: According to currently recommended protocols, about one-third of healthy women are eligible for intrapartum antibiotics to prevent neonatal GBS sepsis. In practice, antibiotics are often used inefficiently because of poor compliance with protocols and poor predictive values of selection criteria. Better implementation strategies should improve compliance, but GBS vaccines are needed to replace prophylactic antibiotic use, with its associated disadvantages.

Gwendolyn L. Gilbert

Moira C. Hewitt

Catherine M. Turner

Stephen R. Leeder

Compliance With Protocols for Prevention of Neonatal Group B Streptococcal Sepsis: Practicalities and Limitations

Directions

Objectives: To determine the in vitro resistance of group B streptococcus (GBS) to 12 antibiotics. To determine
if there has been any decrease in sensitivity to the penicillins or other antibiotics currently used for GBS
chemoprophylaxis in pregnant women. Find suitable alternative antibiotics to penicillin. Find an antibiotic that will
have minimal selective pressure for resistance among the endogenous resident vaginal microflora.Methods: The antibiotic susceptibility profiles of 52 clinical isolates of GBS were evaluated to 12 antibiotics:
ampicillin, azithromycin, cefamandole, cefazolin, ceftriaxone, ciprofloxacin, clindamycin, erythromycin, nitrofurantoin,
ofloxacin, penicillin and vancomycin. Antibiotic sensitivities were determined using disk diffusion and
microdilution methods according to the guidelines of the National Committee for Clinical Laboratory Standards
(NCCLS).Results: All isolates were sensitive to vancomycin, ofloxacin, ampicillin, ciprofloxacin, nitrofurantoin and penicillin.
However, the following number of clinical isolates exhibited intermediate or decreased sensitivity, nine (17&#x25;) to
ampicillin, eight (15&#x25;) to penicillin, 14 (32&#x25;) to ciprofloxacin and one (2&#x25;) to nitrofurantoin. Thirty-one percent
of the isolates were resistant to azithromycin and ceftriaxone, 19&#x25; to clindamycin, 15&#x25; to cefazolin and 13&#x25; to
cefamandole. Eighteen (35&#x25;) of the clinical isolates tested were resistant to 6 of the 12 antibiotics tested.Conclusions: The relatively high rates of resistance for 6 of the 12 antibiotics tested suggest that for women allergic
to penicillin and colonized with GBS, antibiotic sensitivities to their isolates should be determined. The antibiotic
selected for intrapartum chemoprophylaxis should be guided by the organism’s antibiotic sensitivity pattern.
Patients with GBS bacteriuria should be treated with nitrofurantoin.

Jose A. Simoes

Alla A. Aroutcheva

Ira Heimler

Antibiotic Resistance Patterns of Group B Streptococcal Clinical
Isolates

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Infectious Diseases in Obstetrics and Gynecology publishes articles related to infectious diseases in women’s health. Topics include diagnosis and treatment of sexually transmitted diseases, urinary tract infections, and infections in pregnancy.

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Infectious Diseases in Obstetrics and Gynecology publishes articles related to infectious diseases in women’s health. Topics include diagnosis and treatment of sexually transmitted diseases, urinary tract infections, and infections in pregnancy.

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Infectious Diseases in Obstetrics and Gynecology

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Infectious Diseases in Obstetrics and Gynecology