Compliance with antibiotic prophylaxis guidelines in caesarean delivery: a retrospective, drug utilization study (indication-prescription type) at an Ecuadorian hospital

Abstract

Background Preoperative antibiotic prophylaxis is essential for preventing surgical site infection (SSI). The aim of this study was to evaluate compliance with international and local recommendations in caesarean deliveries carried out at the Obstetrics and Gynaecology Service of the Ambato General Hospital, as well as any related health and economic consequences. Methods A retrospective indication-prescription drug utilization study was conducted using data from caesarean deliveries occurred in 2018. A clinical pharmacist assessed guidelines compliance based on the following criteria: administration of antibiotic prophylaxis, antibiotic selection, dose, time of administration and duration. The relationship between the frequency of SSI and other variables, including guideline compliance, was analysed. The cost associated with the antibiotic used was compared with the theoretical cost considering total compliance with recommendations. Descriptive statistics, Odds Ratio and Pearson Chi Square were used for data analysis by IBM SPSS Statistics version 25. Results The study included 814 patients with an average age of 30.87 ± 5.50 years old. Among the caesarean sections, 68.67% were emergency interventions; 3.44% lasted longer than four hours and in 0.25% of the deliveries blood loss was greater than 1.5 L. Only 69.90% of patients received preoperative antibiotic prophylaxis; however, 100% received postoperative antibiotic treatment despite disagreement with guideline recommendations (duration: 6.75 ± 1.39 days). The use of antibiotic prophylaxis was more frequent in scheduled than in emergency caesarean sections (OR = 2.79, P = 0.000). Nevertheless, the timing of administration, antibiotic selection and dose were more closely adhered to guideline recommendations. The incidence of surgical site infection was 1.35%, but tended to increase in patients who had not received preoperative antibiotic prophylaxis (OR = 1.33, P = 0.649). Also, a significant relationship was found between SSI and patient age (χ2 = 8.08, P = 0.036). The mean expenditure on antibiotics per patient was 5.7 times greater than that the cost derived from compliance with international recommendations. Conclusions Surgical antibiotic prophylaxis compliance was far below guideline recommendations, especially with respect to implementation and duration. This not only poses a risk to patients but leads to unnecessary expenditure on medicines. Therefore, this justifies the need for educational interventions and the implementation of institutional protocols involving pharmacists.

Compliance with Antibiotic Prophylaxis in Obstetric and Gynecological Surgeries in Two Peruvian Hospitals

“…Antibiotic prophylaxis is aimed at obtaining bactericidal levels in the tissue at the time of the incision and at reducing the bacterial load intraoperatively [12]. Although antibiotic prophylaxis has proven to be an effective tool in preventing SSIs, in Peru and many other countries, its use is not regulated [13]. In hospitals with procedural guidelines, medical prescribers often do not follow them adequately.…”

Prophylactic antibiotic use during labor and delivery in China: a nationwide, multicenter, hospital-based, cross-sectional study

“…The WHO guideline strongly recommends prophylactic antibiotics for cesarean deliveries unless the patient is already receiving an antibiotic regimen with equivalent broad spectrum coverage for existing infectious [ 1 , 12 ]. The adherence prevalence for cesarean deliveries in this study (93%) was much higher than in Kosovo (66%) and Ecuador (70%) [ 22 ].…”

Antibiotic Use in Caesarean Section among Obstetricians and Gynaecologists in the Second Largest City in Indonesia

“…In many countries, compliance with hospital protocols, specifi cally with the administration of antibiotics, remains a challenge. 26,28 In Indonesia, most obstetricians practice in more than one hospital (including private practice/clinic), lowering their adherence to the service protocol. This research refl ects the mindset of obstetricians providing services at three hospitals.…”