Mehl + UW BGstrep prophylaxis 03-25 (2) Flashcards
(34 cards)
Mehl. what is adequate prophylaxis? abs + time of injection.
Adequate prophylaxis is considered to be IV penicillin or ampicillin administered within 4 hours of completion of Stage 2 (delivery of fetus; stages of delivery discussed later).
Mehl. what is wrong answer in 2CK?
Oral amoxicillin + clavulanate (Augmentin) is wrong. This is listed as wrong answer choice on 2CK form.
Mehl. we do not automatically give GBS prophylaxis in the current pregnancy just because the woman had a (+) culture in the PRIOR pregnancy.
When discussing indications for giving GBS prophylaxis, the first step is mentioning when you do not give it, which is when there is Hx of mere colonization with GBS in prior pregnancy.
Mehl. Knowing not to give it in this scenario is actually the highest yield point.
.
Mehl. Indications for giving GBS prophylaxis. what positive? when?
(+) Rectovaginal swab at 36 weeks.
Mehl. Indications for giving GBS prophylaxis. urine?
GBS bacteriuria at any point during the pregnancy, even if it was successfully treated.
if they say woman had 1st trimester GBS asymptomatic bacteriuria + she received ampicillin or penicillin + cultures are currently negative, we still give intrapartum prophylaxis.
Mehl. Indications for giving GBS prophylaxis. Hx of what?
Hx of early-onset GBS disease in prior pregnancy (i.e., meningitis, pneumonia, or sepsis) in NEONATE.
This is different from mere colonization in the mom while pregnant. In this scenario, the neonate actually went on to get a GBS infection.
Mehl. Indications for giving GBS prophylaxis.
- If mother’s GBS status is unknown or equivocal, we give it if any one of the following is present:? 3
1) Rupture of membranes (ROM) > 18 hours.
2) Maternal fever >38 C.
3) Preterm delivery (<37 weeks).
Mehl. 2CK Obgyn form, for instance, says that a pregnant woman is in labor at 40 weeks, her temperature is 37
C, and her GBS status is unknown. They ask which of the following is the best indication for prophylaxis in this patient –> answer = ROM > 18 hours.
.
Mehl. Another 2CK Obgyn Q asks for the Tx of GBS sepsis in the neonate –> answer = ampicillin + gentamicin;
vancomycin + ceftriaxone is wrong on the form.
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Mehl. Not GBS table.
Three most common bacteria causing infections in neonates are?
GBS, Ecoli, listeria
Mehl. Not GBS table.
If they say there is neonatal infection caused by gram-positive cocci, answer?
GBS
If they say there is neonatal infection caused by gram-negative rod, answer?
E coli
If they say there is neonatal infection caused by gram-positive rod, answer?
Listeria
Mehl. Not GBS table. listeria spread?
Listeria can be contracted by the pregnant female via soft cheeses and deli meats.
UW table. antenatal screenin, weeks?
new table tipo sako 36-38 weeks.
UW table. indications. urinary?
GBS bacteriuria or GBS urinary infection in current or prior pregnancy (regardless or treatment)
UW table. indications. culture?
GBS positive rectovaginal culture (mehl. said 36 weeks) in current pregnancy
UW table. indications. Unknown GBS status PLUS any of the following?3
<37 weeks gestation
Intrapartum fever
Rupture of membrane >= 18 hours
UW table. indications. Prior what disease?
Prior infant with early-onset neonatal GBS infection
UW table. intrapartum prophylaxis. What abs? what is allergy?
First line Iv penicillin or (ampicillin)
IF allergy –> give cefazolin
UW case.
First line Iv penicillin or (ampicillin)
because they reach high bactericidal concentrations in the amniotic fluid rapidly (eg, within 3-4 hours), have no fetal toxicity, and have a narrow spectrum of coverage, thereby minimizing bacterial resistance.
.
UW case. Patient has penicillin allergy => what abs to give?
cefazolin (a first-generation cephalosporin).
Cephalosporins have a lower risk of cross-reactivity but achieve the same high bactericidal concentrations in the amniotic fluid without fetal toxicity.
UW case - was GBS erythromycin resistant. what other abs cannot be given?
erythromycin resistance is associated with inducible clindamycin resistance