Morbidity in Pregnant Women with Group-B Streptococcus Infection and Unverified Penicillin Allergy
Saturday, March 5, 2016
South Exhibit Hall H (Convention Center)
Shilpa Desai, MD, Qiaoling Chen, MS, Michael S. Kaplan, MD FAAAAI, Scott Rasgon, MD, Eric M. Macy, MD FAAAAI
Rationale: The morbidity potentially associated with unverified penicillin allergy in pregnant women with group B streptococcus (GBS) colonization is unknown.  Penicillin allergy testing has been shown to be safe in pregnant women, but is done infrequently. We retrospectively determined healthcare utilization and morbidity in a large cohort of pregnant women with GBS with and without an unverified history of penicillin allergy.

Methods: All pregnant women with a positive culture for GBS in a five year period, 1-1-2009 to 12-31-2014, were identified using Southern California Kaiser Permanente electronic health records. Those with a history of an active, but unverified, penicillin allergy noted prior to delivery were compared to those with no penicillin allergy history.  Method of delivery, hospital utilization over the 6 months after delivery, and antibiotic exposures within 3 days of delivery was determined.

Results: There were 39,374 (23.1%) GBS-positive women with 42,524 pregnancies, 3,500 (8.2%) with unverified penicillin allergy and 39,024 (91.8%) with no history of penicillin allergy. There were significantly more caesarean sections in women with unverified penicillin allergy, 30.4% versus 27.6% (p=0.0004).  Mothers with unverified penicillin allergy spent significantly more days in the hospital in the 6 months after delivery, 3.55±1.51 versus 3.46±2.00 (p = 0.002).  GBS-positive pregnant women with unverified penicillin allergy were significantly more likely to receive clindamycin or vancomycin.  Only 7 GBS-positive women had penicillin allergy testing at Kaiser Permanente Southern California during this time.

Conclusions: Penicillin allergy testing pregnant women who are GBS-positive prior to delivery may result in decreased hospital utilization, as well as less morbidity.