Intrapartum Group B Streptococcus Antibiotic Prophylaxis in Penicillin Allergic Pregnant Women

Abstract

Objectives To estimate the prevalence of and identify modifiable risk factors for alternative antibiotics for group B Streptococcus (GBS) prophylaxis in penicillin-allergic women. Methods Retrospective cohort study of pregnant women within a health care network from January 1, 2014, to December 31, 2017. Included women were GBS colonized, delivered at ≥ 37 weeks' gestation, and reported penicillin/cephalosporin allergy. The primary outcome was the use of alternate antibiotics GBS prophylaxis, defined per Centers for Disease Control and Prevention guidelines as antibiotics other than penicillin, ampicillin, or cefazolin. Results We identified 190 GBS-colonized pregnant women self-reporting a penicillin/cephalosporin allergy; 5% reported anaphylaxis, 44% high-risk symptoms (isolated hives, shortness of breath, swelling, or vomiting), and 51% low-risk symptoms (isolated rash, itching, or nausea). Two-thirds (63%) had alternative antibiotic prophylaxis. In adjusted analyses, nonwhite race (adjusted odds ratio [aOR]: 2.42; 95% confidence interval [CI]: 1.19–4.94) and high-risk allergic reaction (aOR: 2.42; 95% CI: 1.30–4.49) were associated with higher odds of alternative antibiotics prophylaxis compared with low-risk allergic reaction. Low-risk allergic reaction group was less likely to receive alternative antibiotic prophylaxis (aOR: 0.36; 95 CI%: 0.19–0.66). Conclusion Alternative antibiotic use for GBS prophylaxis is frequent with penicillin/cephalosporin allergies. Efforts to confirm allergy and perform penicillin hypersensitivity testing may increase compliance with guidelines for antibiotic administration.

Oral probiotics to reduce vaginal group B streptococcal colonization in late pregnancy

“…Newborns exposed to IAP show higher incidences of thrush and allergic sensitivities 11 , 16 . In addition, IAP involves the possibility of maternal anaphylaxis 17 , and increasing rates of resistance to antibiotic agents necessitate alternatives to conventional IAP 18 .…”

Antibiotic prophylaxis in beta-lactam allergic patients undergoing cesarean and vaginal delivery: An opportunity for stewardship

“…Previous studies have evaluated inappropriate or guideline discordant antibiotic use for penicillin allergic patients in the obstetrics population. 8,9 However, to our knowledge, our study is the first to evaluate appropriateness of antibiotics based on side-chain cross reactivity, and we found that most patients who received a non-β-lactam prophylaxis likely could have safely received cefazolin. Given the inferior outcomes and greater side-effect profile of non-β-lactam alternatives, 10 it is imperative that efforts be made to maximize β-lactam utilization in patients with a β-lactam allergy label.…”

Outpatient Penicillin Allergy Testing in Pregnant Women Who Report an Allergy

“…In a previously published study, we examined 190 pregnant women who tested positive for group B streptococcus infection over a 3-year period who delivered at term who also had a self-reported penicillin or cefazolin allergy. 8 Women with low risk allergic-reaction (rash, itching or unknown reaction) represented 58% (99/171) of our penicillin-allergic group and would have been suitable candidates for confirmatory allergy testing. 8 Penicillin allergy testing during pregnancy is recommended for moderate risk groups too, inclusive of women reporting urticaria.…”

“… 8 Women with low risk allergic-reaction (rash, itching or unknown reaction) represented 58% (99/171) of our penicillin-allergic group and would have been suitable candidates for confirmatory allergy testing. 8 Penicillin allergy testing during pregnancy is recommended for moderate risk groups too, inclusive of women reporting urticaria. 18 This suggests that up to 94% of women would have been eligible for penicillin allergy testing.…”

“…Pregnant women with a self-reported penicillin allergy typically receive alternative antibiotics that are broader spectrum (eg, cefazolin, clindamycin, vancomycin), which increases risk for antibiotic resistance and maternal morbidity. 1 , 6 – 8 In the general population, self-reported penicillin allergy occurs in 10% of patients, however when tested, fewer than 2% have a proven (or true) allergic reaction. 9 , 10 Penicillin allergy also decreases over time, with up to 80% of patients with a confirmed penicillin allergy losing sensitization 10 years later.…”