Prevention early-onset gbs sepsis: implementation of the proposed CDC guidelines

Objectives: The purpose of the study was to document the impact of the introduction into clinical practice of the proposed CDC guidelines for prevention of early onset GBS disease. Study Design: A retrospective study comparing the prevalence of early onset GBS sepsis (positive blood culture GBS) at Magee-Womens Hospital prior to the institution of CDC guidelines (January 1, 1992-June 30, 1995) with the prevalence of GBS sepsis following introduction of the CDC protocol (October 1, 1995-March 31, 1996). The microbiology laboratory data base was reviewed for all positive GBS blood cultures from the nursery, as were the medical records of blood culture GBS positive newboms. Results: From January 1, 1992-June 30, 1995 there were 36 cases of early onset GBS sepsis among 31,133 births for a rate of 1.15 per 1000 live births. After introduction of the CDC protocol there was 1 case of early onset GBS sepsis in 5500 births or 18 per 1000 live births (p=0.03). During these time periods the prevalence of maternal GBS vaginal colonization remained the same (27% vs 25%) By March, 1996 intrapartum prophylaxis for GBS was the most common new antibiotic order accounting for 36% of new antibiotic orders at MWH Post introduction of the CDC protocol, IV penicillin made up 83.2% of these orders, clindamycin 13.2%, erythromycin 0.5%, amyicillin 1.3% and other 1.8%. Conclusions: The proposed CDC guidelines for prevention of early onset GBS infection in newborns is very effective, reducing early onset GBS > 5-fold Institution of the CDC protocol was easily accomplished in a large community hospital where two-thirds of deliveries are by private attendings.