Successful control program to implement the appropriate antibiotic prophylaxis for cesarean section

Abstract

SUMMARYObjective: Describe implementation of a successful program to reduce doses (cefazolin 2 to 1 g) used for antimicrobial prophylaxis. Methods: Evaluation of an intervention program to reduce prophylactic antimicrobial doses. The intervention included weekly staff discussions, automatic dispensation of 1g-vial of cefazolin by the pharmacy unless expressly requested by surgeon and increase in post-discharge surveillance as a strategy to reassure surgeons of the safety of the reduction. In the pre and post intervention periods, a prospective study of antimicrobial consumption and surgical site infections were measured. Results: There were 5, 164 and 5,204 deliveries in 2001-2002 and 2003-2004, respectively; 1,524 (29.5%) and 1,363 (26%) were cesarean sections. There was a 45% decrease in cefazolin vials used on average per cesarean section (2.29 to 1.25). Patients evaluated increased from 16% to 67% and the SSI rates in both periods were 3.34% to 2.42%, respectively. Conclusion: An ample intervention, including administrative and educational measures, led to high compliance with dose reduction and saved more than US$4,000 in cefazolin, considered important because government reimbursement in Brazil for cesarean section is $80. KEYWORDS:Antimicrobial prophylaxis; Cesarean section; Compliance; Cefazolin; Surgical site infection.Major postoperative infectious complications such as endometritis and surgical site infection are important causes of maternal morbidity 10 . Antibiotic prophylaxis is recommended in order to decrease infectious complications in high risk cesarean sections 1,2,26 . In 1990, EHRENKRANZ et al. 10 demonstrated that routine timely antibiotic prophylaxis might be associated with a 70% to 75% reduction of risk of either endometritis or wound infection in low-risk cesarean sections. CHELMOW et al. 8 confirmed these findings in a meta-analysis demonstrating that prophylactic antibiotic use in low-risk cesarean sections was associated with a significant reduction in postoperative fever and endometritis. More recently, in a cost-analysis study this same group 7 concluded that administration of prophylactic antibiotics for elective cesarean delivery reduced costs by US$30.66 per case resulting in cost savings for elective cesarean delivery. Most clinical guidelines 2,9,11,13,23,27 advocate the use of a single dose of 1 to 2 g of cefazolin right after the clamping of the cord in cesarean deliveries. Increasing healthcare costs have led (or forced) hospitals and clinics to review procedures, in order to adjust their budgets. Also, concerns with antimicrobial resistance have pressured infection control specialists to decrease antimicrobial usage. There is a variation of dosage of cefazolin in the randomized controlled trials and both 1 and 2 grams are doses suggested in guidelines. To achieve the aim of the most cost effectiveness under limited resources, a single dose of 1 gram administered immediately after cord clamping among women undergoing cesarean section is the most appropriate. Despite th...

Pengaruh Pemberian Antibiotik terhadap Tanda Infeksi Daerah Operasi Superfisial dan Lama Tinggal Pasien Sectio Caesaria

“…(15) Penggunaan antibiotik profilaksis secara bijak (tidak berkelanjutan pascaoperasi) pada operasi SC juga terbukti menekan angka pembelian antibiotik. (15,16) Federspiel et al pada penelitiannya yang melibatkan sampel cukup besar mencatat bahwa sebagian besar pasien dengan SC (46.8%) sebenarnya hanya membutuhkan 2 hari perawatan pascaoperasi SC. (17) Hal ini memiliki tendensi bahwa kemungkinan pemberian antibiotik lanjutan pascaoperasi SC di rumah sakit justru memperpanjang LOS akibat menunggu selesainya pemberian antibiotik intravena pascaoperasi SC di rumah sakit.…”