Compliance with the Centers for Disease Control and Prevention antenatal culture protocol for preventing group B streptococcal neonatal sepsis

OBJECTIVE: Our purpose was to measure the compliance with the Centers for Disease Control and Prevention antenatal culture protocol for preventing group B streptococcal sepsis after extensive education of physicians and staff. STUDY DESIGN: After 2 months of educational activities to familiarize attending physicians, nurses, and laboratory staff with the guidelines, a retrospective chart review of all vaginal deliveries over a 6-month period were analyzed for protocol compliance and failures either of culturing or antibiotic use. RESULTS: Overall, there was a 20% prevalence rate of group B streptococci found at greater than or equal to 35 weeks' gestation. The enhanced broth preincubation did not significantly increase this rate. Compliance with the protocol was 80% for appropriately timed cultures and 84% for use of antibiotics; 0.7% received unindicated antibiotics. CONCLUSION: The area of greatest compliance failure was neglecting to treat women with antepartum risk factors that did not require antepartum cultures: previously affected neonates with group B streptococcal sepsis, antepartum group B streptococcal bacteriuria, and preterm labor and delivery. Twenty-one percent (14/66) of women having these antepartum risk factors were not treated. Protocol failure resulting in no cultures being done occurred in 9% of the women studied (87/956). Further education and quality assurance activities can lower these numbers. There were no cases of group B streptococcal sepsis during the 6 months of this study.