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April 2008

Volume 29, Number 4
Infect Control Hosp Epidemiol 2008;29:327–332
© 2008 by The Society for Healthcare Epidemiology of America. All rights reserved.
0899-823X/2008/2904-0008$15.00
DOI: 10.1086/529210
Original Article

Effect of Intrapartum Antibiotic Prophylaxis Against Group B Streptococcal Infection on Comparisons of Rates of Endometritis and Urinary Tract Infection in Multicenter Surveillance

Anne‐Marie Dumas, MD;

Raphaëlle Girard, MD;

Louis Ayzac, MD;

Geneviève Beaumont, MWc;

Emmanuelle Caillat‐Vallet, MSc;

Florence Depaix, RNc;

Chantal Gignoux, MWc;

Catherine Haond, MD;

Noelle Pral, MWc;

Jacqueline Robert, MWc;

Françoise Tissot‐Guerraz, MD;

Agnès Vincent‐Bouletreau, MD;

Michel Berland, MD;

Jacques Fabry, MD

From the Service de Gynécologie Obstétrique (A.M.D., M.B.) and the Service d'Hygiène et Épidémiologie (R.G.), Centre Hospitalier Lyon Sud, Pierre Bénite, and the Centre de Coordination de la Lutte Contre les Infections Nosocomiales Sud‐Est (L.A., G.B., E.C.‐V., F.D., C.G., C.H., N.P., J.R., F.T.‐G., A.V.‐B., J.F.), Saint Genis Laval, France.

Objective.To establish whether antibiotic prophylaxis against group B streptococcal infection may be a confounding factor in comparisons of rates of endometritis and urinary tract infection after vaginal delivery.

Design.Prospective study.

Setting.Maternity units at 48 hospitals in a regional surveillance network in France during 2001‐2004.

Methods.The maternity units used a common protocol to establish whether antibiotic prophylaxis was indicated. Risk factors for endometritis and urinary tract infections were evaluated using multiple logistic regression.

Results.We analyzed 49,786 vaginal deliveries. The percentage of women receiving antibiotic prophylaxis varied widely and significantly among the maternity units (range, 4.4%‐26.0%; median, 15.8%; 25th percentile, 12.1%; 75th percentile, 19.0%) ( , by Mantel‐Haenszel χ2 test). The incidence rate of endometritis was significantly reduced from 0.25% to 0.11% by antibiotic prophylaxis ( ). There was a decrease in the incidence of urinary tract infection from 0.37% to 0.32%, but it was not statistically significant ( ).

Conclusions.A reduction in the incidence of endometritis was observed when intrapartum antibiotic prophylaxis against group B streptococcal infection was used. However, the proportion of women considered to be at risk of infection varied widely among institutions. Comparisons of rates of endometritis among maternity units, but not urinary tract infection rates, should take into account antibiotic prophylaxis as a significant confounding factor.

Received August 10, 2007; accepted December 10, 2007; electronically published March 3, 2008.

Address reprint requests to Anne‐Marie Dumas, MD, Centre Hospitalier Lyon Sud, Service de Gynécologie Obstétrique, Batiment 3B, Pierre Bénite Cedex, 69495 Pierre Bénite, France ().
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