TY - JOUR
T1 - Evaluation of appropriate vancomycin prescribing for the prevention of newborn group B streptococcal infections in a community hospital obstetrics service
AU - Assabahi, Amirah
AU - Driggers, Rita
AU - Keeys, Christopher A.
AU - Mader, Alexa
AU - Norris, Paul
N1 - Publisher Copyright:
© 2022 Walter de Gruyter GmbH, Berlin/Boston.
PY - 2022/11/1
Y1 - 2022/11/1
N2 - Objectives: The 2019 American College of Obstetricians and Gynecologists (ACOG) guidelines update for the prevention of perinatal group B Streptococcus (GBS) infections stipulate that vancomycin should be reserved to treat penicillin-allergic women at high risk for anaphylaxis with documented GBS resistance to clindamycin. Protocols and policies were adapted at the community hospital to incorporate these new guidelines. The primary objective of this research was to evaluate institutional compliance to these guidelines and secondarily, clinical outcomes. Methods: Clinical pharmacists, in collaboration with an obstetrician, performed this hospital-based study. All instances of intravenous (IV) vancomycin therapy in GBS-positive patients were assessed from 1/1/2018 through 1/1/2021 and compared to the 2010 and 2019 ACOG guidelines. Treatment was analyzed to determine the appropriateness of both indication for use and dosage regimen as co-primary endpoints. Secondary endpoints included renal monitoring parameters, suspected adverse reactions, and early onset GBS disease in newborns, specifically sepsis, meningitis, and/or pneumonia. Results: L&D admissions during the study period included 15,129 patients. All 30 L&D patients who received IV vancomycin for GBS prophylaxis were included in the study. This project demonstrated low compliance to the ACOG guidelines and identified previously unrecognized opportunities for improvement. Conclusions: The low compliance observed in this study, with the exception of documenting GBS status, occurred in spite of hospital adoption of a GBS order set, an updated vancomycin protocol and targeted education of clinical pharmacists. Assessment of the causes of noncompliance identified several potential corrective actions, especially in ordering and monitoring vancomycin.
AB - Objectives: The 2019 American College of Obstetricians and Gynecologists (ACOG) guidelines update for the prevention of perinatal group B Streptococcus (GBS) infections stipulate that vancomycin should be reserved to treat penicillin-allergic women at high risk for anaphylaxis with documented GBS resistance to clindamycin. Protocols and policies were adapted at the community hospital to incorporate these new guidelines. The primary objective of this research was to evaluate institutional compliance to these guidelines and secondarily, clinical outcomes. Methods: Clinical pharmacists, in collaboration with an obstetrician, performed this hospital-based study. All instances of intravenous (IV) vancomycin therapy in GBS-positive patients were assessed from 1/1/2018 through 1/1/2021 and compared to the 2010 and 2019 ACOG guidelines. Treatment was analyzed to determine the appropriateness of both indication for use and dosage regimen as co-primary endpoints. Secondary endpoints included renal monitoring parameters, suspected adverse reactions, and early onset GBS disease in newborns, specifically sepsis, meningitis, and/or pneumonia. Results: L&D admissions during the study period included 15,129 patients. All 30 L&D patients who received IV vancomycin for GBS prophylaxis were included in the study. This project demonstrated low compliance to the ACOG guidelines and identified previously unrecognized opportunities for improvement. Conclusions: The low compliance observed in this study, with the exception of documenting GBS status, occurred in spite of hospital adoption of a GBS order set, an updated vancomycin protocol and targeted education of clinical pharmacists. Assessment of the causes of noncompliance identified several potential corrective actions, especially in ordering and monitoring vancomycin.
KW - GBS early onset neonatal infection
KW - group b Streptococcus (GBS)
KW - guidelines
KW - vancomycin
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U2 - 10.1515/jpm-2021-0558
DO - 10.1515/jpm-2021-0558
M3 - Article
C2 - 35794077
AN - SCOPUS:85141894528
SN - 0300-5577
VL - 50
SP - 1218
EP - 1224
JO - Journal of Perinatal Medicine
JF - Journal of Perinatal Medicine
IS - 9
ER -