Abstract
Objective
To evaluate the impact of a standardized allergy-guided approach to Group B Streptococcus (GBS) prophylaxis in pregnant women with reported penicillin or cephalosporin allergy.
Methods
This interrupted time-series analysis included obstetric patients requiring GBS prophylaxis
who reported penicillin or cephalosporin allergies. Patients were divided into baseline
(April 1, 2019 to July 21, 2020) and intervention (July 22, 2020 to July 31, 2021)
groups. The primary outcome was prophylaxis appropriateness, based on antibiotic type,
nature of reaction, and cross-reactivity risk. Secondary outcomes included type of
prophylaxis received and antibiotic-related adverse events.
Results
The study included 88 patients in the baseline period and 52 patients in the intervention
period. Appropriate prophylaxis increased from 47% (41/88) to 85% (44/52), with the
segmented regression model confirming a statistically significant increase over time
(incidence rate ratio 1.57; 95% CI 1.02–2.43, P = 0.04, slope coefficient 1.06/month; 95% CI 1.01–1.10, P = 0.01). Penicillin and cefazolin use increased from 61% (54/88) to 87% (45/52) in
the intervention period (P = 0.002), and no hypersensitivity reactions occurred during this period.
Conclusions
Implementation of standardized allergy-guided prophylaxis safely improved appropriate
β-lactam antibiotic use in obstetric patients requiring GBS prophylaxis who reported
penicillin and cephalosporin allergies.
Résumé
Objectif
Évaluer les effets d’une démarche normalisée centrée sur les allergies pour la prophylaxie
des infections à streptocoque du groupe B (SGB) chez les femmes enceintes réputées
allergiques à la pénicilline ou à la céphalosporine.
Méthodologie
Cette analyse de séries chronologiques interrompues concerne des patientes en obstétrique
réputées allergiques à la pénicilline ou à la céphalosporine et nécessitant une prophylaxie
anti-SGB. Les patientes ont été divisées en deux groupes selon une période de référence
(1er avril 2019 au 21 juillet 2020) et une période d’intervention (22 juillet 2020 au
31 juillet 2021). Le critère de jugement principal était la pertinence de la prophylaxie
en fonction du type d’antibiotique, de la nature de la réaction et du risque de réactivité
croisée. Les critères de jugement secondaires visaient le type de prophylaxie reçue
et les événements indésirables liés à l’antibiotique.
Résultats
L’étude compte 88 patientes dans la période de référence et 52 dans la période d’intervention.
La prophylaxie pertinente a augmenté de 47 % (41/88) à 85 % (44/52), et le modèle
de régression segmentée confirme l’augmentation statistiquement significative dans
le temps (rapport du taux d’incidence : 1,57; intervalle de confiance [IC] à 95 %
: 1,02–2,43, p = 0,04, coefficient de pente : 1,06/mois; IC à 95 % : 1,01–1,10, p = 0,01). L’utilisation de pénicilline ou de céfazoline est passée de 61 % (54/88)
à 87 % (45/52) dans la période d’intervention (p = 0,002), et aucune réaction d’hypersensibilité n’est survenue pendant cette période.
Conclusions
La mise en œuvre d’un protocole normalisé de prophylaxie centrée sur les allergies
a amélioré de façon sécuritaire l’utilisation adéquate de l’antibiothérapie aux bêta-lactamines
chez les patientes en obstétrique réputées allergiques à la pénicilline ou à la céphalosporine
nécessitant une prophylaxie anti-SGB.
Keywords
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Article info
Publication history
Published online: March 22, 2022
Accepted:
February 25,
2022
Received:
December 13,
2021
Footnotes
Disclosures: The authors declare they have nothing to disclose.
All authors have indicated they meet the journal’s requirements for authorship.
Identification
Copyright
© 2022 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
