GBS = group B Streptococcus; IV = intravenous. Data from the Verani, 2010 for prophylaxis, and ampicillin is an acceptable alternative Women undergoing cesarean delivery before labor onset with (T able 64-3). Women with a penicillin allergy and no hisintact membranes do not need intrapartum GBS chemoprophytory of anaphylaxis are given cefazolin (Briody, 2016). hose laxis, regardless of GBS colonization status or gestational age. at high risk for anaphylaxis should have antimicrobial susceptibility testing performed to exclude clindamycin resistance. Clindamycin-sensitive but erythromycin-resistant isolates • Methicillin-Resistant Staphylococcus aureus should have a D-zone test performed to assess for inducible Staphylococcus aureus is a pyogenic gram-positive organism and clindamycin resistance. If clindamycin resistance is conirmed, is considered the most virulent of the staphylococcal species. vancomycin should be administered. Eythromycin is no longer It primarily colonizes the nares, skin, genital tissues, and oroused or penicilin-alergic patients. pharynx. Approximately 20 percent of normal individuals are
Further recommendations for management of spontanepersistent carriers, 30 to 60 percent are intermittent carriers, ous preterm labor, threatened preterm delivery, or preterm and 20 to 50 percent are noncarriers (Gorwitz, 2008). Coloprematurely ruptured membranes are shown in Figure 64-7. nization is considered the greatest risk factor for infection
Onset of labor orrupture of membranes at < 37 weeks' gestation with significant risk for imminent preterm delivery rectal GBS culture -...for�48hours prophylaxis
FIGURE 64-7 Sample algorithm for prophylaxis for women with group B streptococcal (GBS) disease and threatened preterm delivery. This algorithm is not an exclusive course of management, and variations that incorporate individual circumstances or institutional preferences may be appropriate. IV = intravenous. (Adapted from Centers for Disease Control and Prevention, 201o6a.) (Marzec, 2016; Sheield, 2013). Methicillin-resistant 5 aureus (MRSA) colonizes only 2 percent of adults but is a signiicant contributor to the health-care burden (Gorwitz, 2008). MRSA infections are associated with increased cost and higher mortality rates compared with those by methicillin-sensitive 5 aureus (NISSA) (Beigi, 2009; Butterly, 2010).
Community-acquired MRSA (CA-MRSA) is diagnosed when identified in an outpatient setting or within 48 hours of hospitalization in a person without traditional risk factors. Such risk factors include prior MRSA infection, hospitalization, dialysis or surgery within the past year, and indwelling catheters or devices (Dantes, 2013). Hospital-associated MRSA (HA-MRSA) infections are nosocomial. Most cases of \1RSA in pregnant women are CA-MRSA.