Attitudes and awareness of Australian women regarding peripartum antibiotic use: A multicentre survey

Black, Matthew; Kothari, Alka; Chawla, Gunjan; Pelecanos, Anita; Zahumensky, Amanda; McDermott, L.; O'Connor, Hannah; Kalma, Benjamin; Eley, Victoria

doi:10.1111/ajo.13587

Cited by 3 publications

(1 citation statement)

References 17 publications

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“…37 Communicating the potential risks of pre-incision antibiotics to patients is challenging, given it is now considered the standard of care. Pregnant women are likely to be broadly aware of the potential side effects of antibiotics, 38 and when surveyed, a majority indicated that they would prefer to receive antibiotics after cord clamping, stating that they did not think the risk of getting an infection themselves was convincing enough to risk short-or long-term complications to their baby. 39 Table 1 shows the known risk factors for post-cesarean surgical site infection.…”

Section: Antib Iotic Prophyl a Xis For Ce Sare An S Ec Ti On: Current...mentioning

confidence: 99%

State of the art: Intrapartum antibiotics in cesarean section, the infant microbiota and allergic diseases

Moore

Navarro

McCarthy

et al. 2023

Acta Obstet Gynecol Scand

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International clinical guidelines for cesarean section recommend administration of prophylactic antibiotics prior to surgical incision for all cases to reduce the global burden of maternal infectious morbidity and mortality around the time of birth. 1,2 The timing is specified as pre-incision to allow therapeutic tissue levels to be obtained at the potential site of infection at the time of incision and for the duration of the procedure. 3 This differs from the previous practice of administering antibiotics after cord clamping. 2 The change came about following evidence that pre-incision antibiotics reduce the incidence of maternal infection without short-term adverse effects for the neonate. 4,5 With rising rates of cesarean section in many countries worldwide, 6,7 this protocol change results in more neonates being exposed to antibiotics prior to birth than ever before. While the short-term

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Section: Antib Iotic Prophyl a Xis For Ce Sare An S Ec Ti On: Current...mentioning

confidence: 99%

State of the art: Intrapartum antibiotics in cesarean section, the infant microbiota and allergic diseases

Moore

Navarro

McCarthy

et al. 2023

Acta Obstet Gynecol Scand

Self Cite

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Intrapartum and postpartum antibiotic use in seven low‐ and middle‐income countries: Findings from the A‐PLUS trial

Saleem,

Yasmin,

Moore

et al. 2024

BJOG

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ObjectiveTo describe the intrapartum and postpartum use of non‐study antibiotics in low‐ and middle‐income countries (LMICs) during the double‐blinded NICHD Global Network Azithromycin in Labor (A‐PLUS) trial.DesignThe antibiotic use sub‐study was a planned prospective, observational sub‐study of the A‐PLUS trial.SettingsThe study was carried out in hospitals or health centres affiliated with eight sites of the Global Network for Women's and Children's Health Research (Global Network) in seven countries: Bangladesh, Pakistan, India (two sites), Kenya, Zambia, The Democratic Republic of the Congo (DRC) and Guatemala.PopulationTotally, 29 278 pregnant women enrolled in the A‐PLUS trial.MethodsWe collected data on 29 278 pregnant women admitted to a facility for delivery related to non‐study antibiotic use overall and during three time periods: (1) in the facility prior to delivery, (2) after delivery until facility discharge and (3) after discharge to 42 days post‐partum.Main Outcome MeasuresNon‐study antibiotic use overall and for treatment or prophylaxis by the site during the three time periods.ResultsOf the 29 278 women in the study, 5020 (17.1%; 95% CI 16.7%–17.6%) received non‐study antibiotics in the facility prior to delivery, 11 956 (40.8%; 95% CI 40.3%–41.4%) received non‐study antibiotics in the facility after delivery, and 13 390 (47.6%; 95% CI 47.0%–48.2%) women received non‐study antibiotics after delivery and after facility discharge. Antibiotics were prescribed more often among women in the Asian and Guatemalan sites than in the African sites. In the three time‐periods, among those receiving antibiotics, prophylaxis was the indication in 82.3%, 97.7% and 90.7% of the cases, respectively. The type of antibiotics used varied substantially by time‐period and site, but generally, penicillin‐type drugs, cephalosporin‐type drugs and metronidazole were used more frequently than other types.ConclusionsAcross the eight sites of the Global Network, in the facility before delivery, and in the post‐partum periods before and after facility discharge, antibiotics were used frequently, but use was highly variable by site and time‐period.

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Cefazolin versus placebo for surgical antibiotic prophylaxis in low-risk cesarean delivery: a feasibility blinded randomized controlled trial

Eley,

Navarro,

Martin

et al. 2024

Preprint

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Background Pre-incisional antibiotics are recommended for all patients having cesarean delivery, despite emerging concerns regarding effects on the infant. In this feasibility blinded randomized controlled trial we aimed to test research processes in low-risk women receiving cefazolin or placebo prior to elective cesarean delivery.Methods The trial was prospectively registered (ACTRN12619001705178). Eligible women were aged ≥ 18 and < 40 years, ≥ 37 weeks gestation, at low risk of surgical site infection (SSI) and recruited from a single tertiary centre. We reported proportions of women eligible and consenting; adherence to perioperative infection prevention; blinding adequacy of staff using Bang’s blinding index; SSI surveillance and diagnosis according to the Centre for Disease Control definitions and patient reported outcome measures using validated questionnaires up to 90 days.Results We screened 1651 women, with 1245 (75%) ineligible based on body mass index or presence of diabetes. Of 287 eligible women, 30 were randomized (11%) with 15 in each group. Reasons for non-participation included “wanting antibiotics” (68, 27%), “no reason” (62, 25%) and lack of research staff (33, 13%). Compliance with perioperative infection prevention occurred in 5 of 7 steps. Spontaneous placental separation occurred in 25 (83%) and Comfeel dressing in 29 (97%). Blinding was adequate for all staff groups. SSI surveillance occurred in 156 of 210 (74%) timepoints. SSI occurred in two patients who received pre-incisional cefazolin and were successfully treated as outpatients. Patient reported outcome questionnaires were completed at 136 of 180 (76%) timepoints. There was no difference in maternal health-related quality of life between the groups.Conclusions Feasibility was impacted by the high-risk population and patient desire for antibiotics. Adherence to perioperative infection prevention practices were high but incomplete. These study processes could be effectively applied in a larger population, targeting low risk maternity patients.Trial Registration Prospectively registered 4/12/2019 with the Australian New Zealand Clinical Trials Registry (ACTRN12619001705178).

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Attitudes and awareness of Australian women regarding peripartum antibiotic use: A multicentre survey

Cited by 3 publications

References 17 publications

State of the art: Intrapartum antibiotics in cesarean section, the infant microbiota and allergic diseases

State of the art: Intrapartum antibiotics in cesarean section, the infant microbiota and allergic diseases

Intrapartum and postpartum antibiotic use in seven low‐ and middle‐income countries: Findings from the A‐PLUS trial

Cefazolin versus placebo for surgical antibiotic prophylaxis in low-risk cesarean delivery: a feasibility blinded randomized controlled trial

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