Survey of Cesarean Delivery Infection Prevention Practices Across US Academic Centers

Argani, Cynthia; Notis, Evie; Moseley, Rachel; Huber, Kerri; Lifchez, Scott D.; Price, Leigh Ann; Zenilman, Jonathan M.; Satin, Andrew J.; Perl, Trish M.; Sood, Geetika

doi:10.1017/ice.2015.161

Cited by 10 publications

(8 citation statements)

References 21 publications

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“…[37][38][39][40] This contrasts with practices in high-resource contexts, such as the U.S., where multiple doses of antibiotics is rare. [41,42] Although the analysis conducted here was exploratory, prior hospitalization was consistently associated with increased risk for maternal ESBL/CRO colonization, implicating the role of healthcare settings in the propagation of AMR. Additionally, there was an association between preterm delivery and maternal vaginal ESBL/CRO colonization but not rectal colonization.…”

Section: Discussionmentioning

confidence: 98%

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Hospital Perinatal Transmission Dynamics of Antimicrobial Resistance, Bangladesh, 2020

Styczynski

Amin

Parveen

et al. 2022

Preprint

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Antimicrobial resistance (AMR) is a growing global health threat that contributes to substantial neonatal mortality. Bangladesh has reported some of the highest rates of AMR among bacteria causing neonatal sepsis. To better understand routes of AMR transmission to newborns, we aimed to characterize the frequency of and risk factors for AMR colonization of mothers and newborns during hospitalization for delivery. We enrolled 177 pregnant women presenting for delivery to a tertiary care hospital in Faridpur, Bangladesh, during February-October 2020. We collected vaginal and rectal swabs from mothers on presentation and after delivery as well as rectal swabs from newborns. We also collected swabs from the hospital environment proximal to the patients. Swabs were plated on chromogenic agars selective for extended-spectrum-beta-lactamase producing organisms (ESBL) and carbapenem-resistant organisms (CRO). We performed univariable and multivariable analyses to determine factors associated with ESBL/CRO colonization. Prior to delivery, 17% of mothers had vaginal colonization and 71% had rectal colonization with ESBLs; 4% had vaginal colonization and 13% had rectal colonization with CROs. Seventy-nine percent of women underwent cesarean deliveries (C-section). Ninety-eight percent of women received prophylactic antibiotics during hospitalization. Following delivery, nearly 90% of mothers and newborns were colonized with ESBLs and over 70% with CROs. Of the 290 environmental samples, 77% were positive for ESBLs, and 69% were positive for CROs. Maternal and newborn colonization at discharge were both associated with C-section (RR for maternal 1.4; 95% CI 1.0-1.8 and newborn 1.3; 95% CI 1.1-1.7). Facility-based deliveries increase exposure to AMR organisms, likely driven by intense use of antibiotics and frequent C-sections. Greater attention should be given to the use of perinatal antibiotics, indications for C-sections, and infection prevention practices to reduce the high prevalence of colonization with antibiotic resistant bacteria.

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Section: Discussionmentioning

confidence: 98%

“…[37–40] This contrasts with practices in high-resource contexts, such as the U.S., where multiple doses of antibiotics is rare. [41,42]…”

Section: Discussionmentioning

confidence: 99%

Hospital Perinatal Transmission Dynamics of Antimicrobial Resistance, Bangladesh, 2020

Styczynski

Amin

Parveen

et al. 2022

Preprint

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“…A few surveys have been published on this subject, most of them evaluating specific procedures [24][25][26], or in general surgical procedures [6]. One survey on colorectal operations covered only a small geographic area [21].…”

Section: Discussionmentioning

confidence: 99%

Awareness of Practice and Comparison with Best Evidence in Surgical Site Infection Prevention in Colorectal Surgery

Badia

Casey

Rubio-Pérez

et al. 2020

Surgical Infections

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Background: The use of mechanical bowel preparation and prophylaxis with oral antimicrobial agents can prevent surgical site infection (SSI) in colorectal surgical procedures, but routine adoption of these and other practices by surgeons has been limited. The aim of this study was to determine the actual practice and surgeon beliefs about preventative measures in elective colorectal operations and to compare them with established recommendations. Methods: Web-based survey was sent to colorectal surgeons assessing knowledge, beliefs, and practices regarding the use of preventative measures for SSI. Results: Of 355 surgeons, 33% had no feedback of SSI rate; 60% believed in evidence for normothermia, wound edge protection, and use of alcohol solution, and reported use of these strategies. There was a discrepancy in the assumed evidence and use of hyperoxia, glove replacement after anastomosis, surgical tools replacement, and saline surgical site lavage. Most of respondents believe that oral antibiotic prophylaxis diminishes infection, but is indicated only by one third of them. Few surgeons believe in MBP, but many actually use it. Most surgeons believe that there is a discrepancy between published guidelines and actual clinical practice. As proper means to implement guidelines, checklists, standardized orders, surveillance, feedback of SSI rates, and educational programs are rated most highly by surgeons, but few of these are in place at their institutions. Conclusions: Gaps in the translation of evidence into practice remain in the prevention of SSI in colorectal surgical procedures. Several areas for improvement have been identified. Specific implementation strategies should be addressed in colorectal units.

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“…However, the evidence for general infection control strategies to prevent healthcare‐associated infections is well established, and addressing risk factors instrisic to the patient was beyond the scope this study. Clinicians mostly understand risk factors for SSI that are intrinsic to the patient, but variation in caesarean section techniques suggests there is more uncertainty regarding best practice from a perioperative and surgical perspective.…”

Section: Discussionmentioning

confidence: 99%

“…Evidence for perioperative strategies and surgical techniques has not been adequately synthesised for nurses and physicians (hereafter referred to as ‘clinicians’) and may not always be accessible, as evidenced by large variation in practice . Available evidence mostly reports effectiveness of individual risk‐reducing strategies, which means up‐to‐date evidence for all potential strategies is not available in a single document.…”

Section: Introductionmentioning

confidence: 99%

Best practice perioperative strategies and surgical techniques for preventing caesarean section surgical site infections: a systematic review of reviews and meta‐analyses

Martín

Beckmann

Barnsbee

et al. 2018

BJOG

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Survey of Cesarean Delivery Infection Prevention Practices Across US Academic Centers

Cited by 10 publications

References 21 publications

Hospital Perinatal Transmission Dynamics of Antimicrobial Resistance, Bangladesh, 2020

Hospital Perinatal Transmission Dynamics of Antimicrobial Resistance, Bangladesh, 2020

Awareness of Practice and Comparison with Best Evidence in Surgical Site Infection Prevention in Colorectal Surgery

Best practice perioperative strategies and surgical techniques for preventing caesarean section surgical site infections: a systematic review of reviews and meta‐analyses

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