Research indicates that, in clinical practice today, many women undergoing cesarean delivery do not receive prophylactic antibiotics, despite guideline recommendations grounded in evidence-based medicine that support such prophylaxis.

　　Dr. Sara G. Brubaker of Columbia University’s Mailman School of Public Health in New York City and colleagues conducted a study that found that, between 2003 and 2010, nearly 40% of women in the United States who underwent cesarean delivery did not receive perioperative antibiotic prophylaxis on the day of delivery—despite the American College of Obstetricians and Gynecologists’ recommendation for prophylactic antibiotic use in this population.
　　Dr. Brubaker and colleagues noted that the generally poor adherence to guideline-recommended regimens for prophylactic medication suggests that clinicians are missing opportunities to prevent infectious diseases through low‑intensity interventions. The study was recently published in the journal Obstetrics & Gynecology and has been reported by Medscape Medical News.
　　Researchers extracted data from the Perspective database, maintained by Premier, which contains inpatient records from more than 500 emergency‑care hospitals across the United States. Between January 2003 and March 2010, they collected information on women aged 18 years or older who underwent cesarean delivery on their first or second day of hospitalization, identifying a total of 1,137,804 cases. Cases with a diagnosis code indicating chorioamnionitis, as well as those with incomplete data for the first day of hospitalization, were excluded.
　　The primary outcome of this study was the perioperative use of antibiotics in cesarean delivery, including antibiotic administration on the day of the procedure. Given that prophylactic antibiotic use is influenced by maternal factors, obstetricians, internists, and hospital‑level characteristics, the researchers employed a mixed-effects linear regression model for statistical analysis. After adjusting for clinical and demographic confounders, they assessed differences in antibiotic utilization across hospitals.
　　The results showed that 59.5% (N = 667,700) of women in the study cohort received perioperative antibiotic prophylaxis on the day of delivery. Since the American College of Obstetricians and Gynecologists issued its recommendation in 2003 that cesarean-delivered patients should receive perioperative prophylactic antibiotics, the rate of such prophylaxis has increased, rising from 52.5% to 63.1% by 2010.
　　According to statistics, adherence to clinical guidelines across the United States is influenced by geographic region: the South has the highest rate of prophylactic medication use (65.5%), followed by the Midwest (59.6%), the West (56.2%), and the East (42.6%).
　　Analysis of clinical characteristics revealed that women who underwent planned cesarean delivery (66.1%) were more likely to receive prophylactic antibiotics than those who had a trial of labor followed by cesarean section (43.7%). The researchers noted that this finding is highly concerning, as trial of labor is now recognized as a potential risk factor for postoperative infections following cesarean delivery.
　　In addition to specific demographic and clinical factors, researchers found substantial variation across hospitals in the prophylactic use of antibiotics, a disparity that could not be fully accounted for by measurable patient, physician, or hospital characteristics.
　　After fully adjusting the statistical model, patient-, obstetrician-, internist-, and hospital-level factors accounted for only 9.4% of the variation in perioperative antibiotic use, whereas 91% of the variation was attributable to differences among hospitals.
　　The prophylactic use of antibiotics is largely driven by clinical practice guidelines rather than by patient or healthcare‑provider demand, suggesting that improvements in prescribing quality might be achievable at these levels. Given the low cost and ease of administration of antibiotics, perioperative antibiotic prophylaxis during cesarean delivery could serve as an ideal quality‑assessment indicator in obstetrics.
　　Author: Bu Bu Fei Yan Source: DXY.cn