Evaluation of appropriate vancomycin prescribing for the prevention of newborn group B streptococcal infections in a community hospital obstetrics service

Amirah Assabahi; Rita Driggers; Christopher A. Keeys; Alexa Mader; Paul Norris

doi:10.1515/jpm-2021-0558

Article

Evaluation of appropriate vancomycin prescribing for the prevention of newborn group B streptococcal infections in a community hospital obstetrics service

Amirah Assabahi , Rita Driggers , Christopher A. Keeys , Alexa Mader and Paul Norris

Published/Copyright: July 8, 2022

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From the journal Journal of Perinatal Medicine Volume 50 Issue 9

Abstract

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.

Keywords: GBS early onset neonatal infection; group b Streptococcus (GBS); guidelines; vancomycin

Corresponding author: Christopher A. Keeys, PharmD, BCPS, Pharmacy Department, Sibley Memorial Hospital – Johns Hopkins Medicine, 5255 Loughboro Road, NW, Washington, DC 20016-2695, USA, Phone: 202 243 5246, E-mail: ckeeys1@jhmi.edu

Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Not applicable.
Ethical approval: The local Institutional Review Board deemed the study exempt from review.

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Received: 2021-10-28

Accepted: 2022-06-16

Published Online: 2022-07-08

Published in Print: 2022-11-25

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https://doi.org/10.1515/jpm-2021-0558

Keywords for this article

GBS early onset neonatal infection; group b Streptococcus (GBS); guidelines; vancomycin