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.

Keywords

GBS prophylaxis - penicillin allergy - cephalosporin allergy

• References

• 1 Schuchat A. Epidemiology of group B streptococcal disease in the United States: shifting paradigms. Clin Microbiol Rev 1998; 11 (03) 497-513
• 2 Regan JA, Klebanoff MA, Nugent RP. ; Vaginal Infections and Prematurity Study Group. The epidemiology of group B streptococcal colonization in pregnancy. Obstet Gynecol 1991; 77 (04) 604-610
• 3 Verani JR, McGee L, Schrag SJ. ; Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC). Prevention of perinatal group B streptococcal disease--revised guidelines from CDC, 2010. MMWR Recomm Rep 2010; 59 (RR-10): 1-36
• 4 Pearlman MD, Pierson CL, Faix RG. Frequent resistance of clinical group B streptococci isolates to clindamycin and erythromycin. Obstet Gynecol 1998; 92 (02) 258-261
• 5 Paccione KA, Wiesenfeld HC. Guideline adherence for intrapartum group B streptococci prophylaxis in penicillin-allergic patients. Infect Dis Obstet Gynecol 2013; 2013: 917304
• 6 Briody VA, Albright CM, Has P, Hughes BL. Use of cefazolin for group B streptococci prophylaxis in women reporting a penicillin allergy without anaphylaxis. Obstet Gynecol 2016; 127 (03) 577-583
• 7 Albin S, Agarwal S. Prevalence and characteristics of reported penicillin allergy in an urban outpatient adult population. Allergy Asthma Proc 2014; 35 (06) 489-494
• 8 Macy E. Penicillin skin testing in pregnant women with a history of penicillin allergy and group B Streptococcus colonization. Ann Allergy Asthma Immunol 2006; 97 (02) 164-168
• 9 Bhattacharya S. The facts about penicillin allergy: a review. J Adv Pharm Technol Res 2010; 1 (01) 11-17
• 10 Philipson EH, Lang DM, Gordon SJ, Burlingame JM, Emery SP, Arroliga ME. Management of group B Streptococcus in pregnant women with penicillin allergy. J Reprod Med 2007; 52 (06) 480-484
• 11 Shenoy ES, Macy E, Rowe T, Blumenthal KG. Evaluation and management of penicillin allergy: a review. JAMA 2019; 321 (02) 188-199
• 12 Sampson HA, Muñoz-Furlong A, Campbell RL. , et al. Second symposium on the definition and management of anaphylaxis: summary report--second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. Ann Emerg Med 2006; 47 (04) 373-380
• 13 Prematta T, Shah S, Ishmael FT. Physician approaches to beta-lactam use in patients with penicillin hypersensitivity. Allergy Asthma Proc 2012; 33 (02) 145-151