No abstract

Objective To evaluate the choice of antibiotic used for intrapartum Group B Streptococcus (GBS) prophylaxis in pregnant individuals with reported penicillin allergies compared to those without reported penicillin allergies and investigate whether there are associated differences in neonatal outcomes. Study Design This retrospective cohort study included mother-infant dyads of GBS positive pregnant individuals who labored and delivered newborns ≥ 35 weeks of gestation at a high-volume urban hospital (2005–2018). The type of antibiotic administered to the mothers for GBS prophylaxis (beta-lactam prophylaxis defined as penicillin-class drug or cefazolin; alternative prophylaxis defined as vancomycin or clindamycin) was compared between those with a penicillin allergy documented in their medical record versus those who did not. Neonatal outcomes included number of postnatal blood draws, antibiotic administration, neonatal intensive care unit (NICU) admission, bacteremia, and hospital length of stay and were compared between groups. Bivariable and multivariable analyses were performed. Results Of 11,334 mother-infant pairs, 1170 (10.3%) mothers had a penicillin allergy documented in their medical record. Of them, 49 (4.2%) received a penicillin, 259 (22.1%) received cefazolin, 449 (38.4%) received clindamycin, and 413 (35.3%) received vancomycin. Patients with a reported penicillin allergy were significantly more likely to receive alternative GBS prophylaxis compared to those without penicillin allergy (73.7% vs. 0.2%, p < 0.01). Neonates of patients who received alternative GBS prophylaxis were significantly more likely to undergo a postnatal lab draw compared to neonates of patients who received beta-lactam antibiotics (20.8% vs. 17.3%, OR 1.25 (95% CI 1.08–1.46)). This significant association persisted after adjusting for potential confounders (aOR 1.23, 95% CI 1.06–1.43). There were no other significant differences seen in other newborn outcomes. Conclusion Pregnant individuals who report a penicillin allergy were more likely to receive alternative antibiotics for GBS prophylaxis compared to those without a penicillin allergy. This was associated with an increased frequency of postnatal blood draws among neonates of mothers with a reported penicillin allergy. Brief summary Administration of alternative intrapartum antibiotic prophylaxis with vancomycin or clindamycin is common in individuals with self-reported penicillin allergy, and maternal alternative antibiotic administration may impact neonatal care, particularly via increased lab draws.

Objective: To evaluate intrapartum Group B Streptococcus (GBS) prophylaxis in women with documented penicillin allergy compared to women without penicillin allergy, and to investigate associated differences in neonatal outcomes. Study Design: This retrospective cohort study included GBS positive pregnant women who had a vaginal delivery or cesarean section after trial of labor at >35 weeks of gestation at a high-volume urban hospital (2005-2018). Management of women who reported penicillin allergy was compared to women without a reported penicillin allergy. Maternal outcome was type of antibiotic administered for GBS prophylaxis (beta-lactam antibiotic prophylaxis defined as administration of penicillin, ampicillin, or cefazolin; alternative antibiotic prophylaxis defined as vancomycin or clindamycin). Neonatal outcomes included number of blood draws, antibiotic administration, neonatal intensive care unit (NICU) admission, and length of stay. Univariate analyses were performed. Results: Of the 11,334 mother-neonate pairs meeting eligibility criteria, 1170 (10.3%) women had a documented penicillin allergy, and of these women 51 (4.4%) had a co-existing cephalosporin allergy. Among women with a reported penicillin allergy (n=1170), 49 (4.2%) received penicillin or ampicillin, 259 (22.1%) received cefazolin, 449 (38.4%) received clindamycin and 413 (35.3%) received vancomycin. Women with documented penicillin allergy were significantly more likely to receive alternative GBS prophylaxis compared to women without penicillin allergy (73.7% vs. 0.2%, p<0.01). Neonates of women who received alternative GBS prophylaxis had more lab draws compared to neonates of women who received beta-lactam antibiotic agents (20.8% vs. 17.3%, p<0.01). Conclusion: Pregnant women with documented penicillin allergy received alternative antibiotics for GBS prophylaxis at a significantly higher frequency than women without a penicillin allergy. This was associated with an increased frequency of blood draws among neonates of mothers with penicillin allergy.