Vancomycin during delivery hospitalizations for women with group B streptococcus

Abstract

Objective

Vancomycin use for intrapartum GBS prophylaxis is not well characterized. The objective of this study was to describe trends in the use of vancomycin among women undergoing vaginal delivery with group B Streptococcus (GBS) colonization.

Methods

An administrative inpatient database that includes medications was analyzed to evaluate antibiotic use in women undergoing vaginal delivery hospitalizations complicated by GBS colonization from January 2006 to March 2015. Patients with other obstetric or infectious indications for antibiotics were excluded. Frequency of use of individual antibiotic agents was determined. The Cochran–Armitage test was used to assess temporal trends. An adjusted log-linear regression model accounting for demographic and hospital factors with vancomycin receipt as the outcome was performed with adjusted risk ratios (aRR) and 95% confidence intervals (CI) as the measure of effect. Hospital level variation in administration of vancomycin was also evaluated.

Results

469,717 deliveries met inclusion criteria and were included in this analysis. Use of vancomycin increased from 0.8% of patients in 2006 to 3.8% of patients in the first quarter of 2015. Comparing 2015 to 2006 both the unadjusted (relative risk 4.89 95% CI 4.26–5.60) and adjusted (aRR 4.52 95% 3.94–5.19) models demonstrated significantly increased likelihood of vancomycin administration. In evaluating hospital level vancomycin use, variation was noted with 8.0% of centers administering vancomycin to ≥6.0% of patients.

Conclusions

Vancomycin is becoming increasingly commonly used for intrapartum GBS prophylaxis. Further research and quality improvements initiatives are indicated to optimize intrapartum GBS antibiotic prophylaxis.

Keywords:

• GBS
• GBS antibiotics
• GBS prophylaxis
• group B streptococcus

Disclosure statement

Dr. Wright has served as a consultant for Tesaro and Clovis Oncology. The other authors did not report any potential conflicts of interest. Each author has indicated that he or she has met the journal’s requirements for authorship.

Additional information

Funding

Friedman is supported by a career development award [K08HD082287] from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health. Dr. D’Alton had a leadership role in ACOG II’s Safe Motherhood Initiative which received funding from Merck for Mothers.