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Santillan DA, Hubb AJ, Nishimura TE, Rosenfeld-O'Tool SR, Schroeder KJ, Conklin JM, Karras AE, Gumusoglu SB, Brandt DS, Miller E, Hunter SK, Santillan MK. Group B Streptococcus Screening and Treatment Adherence in Pregnancy: A Retrospective Cohort Study and Opportunities for Improvement. AJPM FOCUS 2022; 1:100028. [PMID: 37791233 PMCID: PMC10546507 DOI: 10.1016/j.focus.2022.100028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction Pregnancy is a time of increased healthcare screening, and past adherence to evolving guidelines informs best practices. Although studies of Group B Streptococcus guideline adherence have focused primarily on treatment of Group B Streptococcus carriers, this study broadly evaluated long-term adherence to both Group B Streptococcus screening and treatment guidelines. Adherence was evaluated across provider types (obstetrics and gynecology, certified nurse midwives, and family medicine). Methods We conducted a retrospective cohort study. Demographic and clinical information were extracted from all prenatal care and delivery patients at a single institution in a single year. Vancomycin prescriptions in pregnancy were tracked for 10 years to determine long-term adherence. Adherence was defined as no deviation from 2010 Group B Streptococcus screening and treatment guidelines. Results Adherence occurred in 89% (1,610/1,810) of patients. Reasons for deviations from guidelines could not always be determined. There was no significant difference in maternal age, race, prenatal provider type, provider type at delivery, gestational age at delivery, delivery mode, or whether antibiotic sensitivities were performed between compliant and noncompliant groups. Significant differences in adherence were found between obstetric clinics (high-risk obstetrics clinic, maternal‒fetal medicine fellows clinic, continuity of care clinic, and faculty private clinic) (p<0.0001) and between the faculty family medicine clinic and resident family medicine clinic (p=0.001). Vancomycin prescription practice did not change significantly over the10-year period. Conclusions High rates of adherence to Group B Streptococcus screening and treatment guidelines in pregnancy have positive implications for reducing antibiotic resistance. Given evolving guidelines, there is a need to periodically evaluate adherence and to re-educate providers about standard practices and best documentation practices.
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Affiliation(s)
- Donna A. Santillan
- Department of Obstetrics and Gynecology, University of Iowa Hospitals & Clinics, Iowa City, Iowa
| | - Alexander J. Hubb
- Carver College of Medicine, University of Iowa Hospitals & Clinics, Iowa City, Iowa
- Department of Obstetrics & Gynecology, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Taryn E. Nishimura
- Department of Obstetrics and Gynecology, University of Iowa Hospitals & Clinics, Iowa City, Iowa
| | - Sandra R. Rosenfeld-O'Tool
- Department of Family Medicine, University of Iowa Hospitals & Clinics, Iowa City, Iowa
- Department of Family Medicine, University of New Mexico Hospital, Albuquerque, New Mexico
| | - Kathleen J. Schroeder
- Department of Family Medicine, University of Iowa Hospitals & Clinics, Iowa City, Iowa
- Department of Family Medicine, Northwestern Medicine Central DuPage Hospital, Wheaton, Ilinois
| | - Jona M. Conklin
- Department of Obstetrics and Gynecology, University of Iowa Hospitals & Clinics, Iowa City, Iowa
- MercyOne Perinatal Center, Perinatal Center of Iowa, Des Moines, Iowa
| | - Alexandra E. Karras
- Department of Obstetrics and Gynecology, University of Iowa Hospitals & Clinics, Iowa City, Iowa
| | - Serena B. Gumusoglu
- Department of Obstetrics and Gynecology, University of Iowa Hospitals & Clinics, Iowa City, Iowa
| | - Debra S. Brandt
- Department of Obstetrics and Gynecology, University of Iowa Hospitals & Clinics, Iowa City, Iowa
| | - Emily Miller
- College of Nursing, The University of Iowa, Iowa City, Iowa
- UCHealth, Loveland, Colorado
| | - Stephen K. Hunter
- Department of Obstetrics and Gynecology, University of Iowa Hospitals & Clinics, Iowa City, Iowa
| | - Mark K. Santillan
- Department of Obstetrics and Gynecology, University of Iowa Hospitals & Clinics, Iowa City, Iowa
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Karmila A, Zulkarnain M, Martadiansyah A, Mirani P, Bernolian N, Gardiner JC, Zhang L. The Prevalence and Factors Associated with Prophylactic Antibiotic Use during Delivery: A Hospital-Based Retrospective Study in Palembang, Indonesia. Antibiotics (Basel) 2021; 10:1004. [PMID: 34439054 PMCID: PMC8388940 DOI: 10.3390/antibiotics10081004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 12/27/2022] Open
Abstract
Prophylactic antibiotic usage during delivery is a common practice worldwide, especially in low- to middle-income countries. Guidelines have been published to reduce antibiotic overuse; however, data describing the use of prophylactic antibiotics and clinician adherence to guidelines in low- to middle-income countries remain limited. This study aimed to describe the prevalence of prophylactic antibiotic use, factors associated with its use, and clinician adherence to guidelines. A retrospective review was conducted for all deliveries from 1 January 2016 to 31 December 2018 at a tertiary level hospital in Indonesia. The prevalence of prophylactic antibiotic use during delivery was 47.1%. Maternal education level, Ob/Gyn specialist-led delivery, a history of multiple abortions, C-section, premature membrane rupture, and antepartum hemorrhage were independently associated with prophylactic antibiotic use. Clinician adherence to the guidelines was 68.9%. Adherence to guidelines was the lowest in conditions where the patient had only one indication for prophylactic antibiotics (aOR 0.36, 95% CI 0.24-0.54). The findings showed that the prevalence of prophylactic antibiotic use during delivery was moderate to high. Adherence to local guidelines was moderate. Updating the local prescribing guidelines may improve clinician adherence.
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Affiliation(s)
- Ariesti Karmila
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI 48824, USA; (A.K.); (J.C.G.)
- Department of Child Health, Faculty of Medicine, University of Sriwijaya, Palembang 30126, Indonesia
| | - Mohammad Zulkarnain
- Department of Public Health, Faculty of Medicine, University of Sriwijaya, Palembang 30126, Indonesia;
| | - Abarham Martadiansyah
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Sriwijaya, Palembang 30126, Indonesia; (A.M.); (P.M.); (N.B.)
| | - Putri Mirani
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Sriwijaya, Palembang 30126, Indonesia; (A.M.); (P.M.); (N.B.)
| | - Nuswil Bernolian
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Sriwijaya, Palembang 30126, Indonesia; (A.M.); (P.M.); (N.B.)
| | - Joseph C. Gardiner
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI 48824, USA; (A.K.); (J.C.G.)
| | - Lixin Zhang
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI 48824, USA; (A.K.); (J.C.G.)
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