The Prevalence and Factors Associated with Prophylactic Antibiotic Use during Delivery: A Hospital-Based Retrospective Study in Palembang, Indonesia

Abstract

Prophylactic antibiotic usage during delivery is a common practice worldwide, especially in low- to middle-income countries. Guidelines have been published to reduce antibiotic overuse; however, data describing the use of prophylactic antibiotics and clinician adherence to guidelines in low- to middle-income countries remain limited. This study aimed to describe the prevalence of prophylactic antibiotic use, factors associated with its use, and clinician adherence to guidelines. A retrospective review was conducted for all deliveries from 1 January 2016 to 31 December 2018 at a tertiary level hospital in Indonesia. The prevalence of prophylactic antibiotic use during delivery was 47.1%. Maternal education level, Ob/Gyn specialist-led delivery, a history of multiple abortions, C-section, premature membrane rupture, and antepartum hemorrhage were independently associated with prophylactic antibiotic use. Clinician adherence to the guidelines was 68.9%. Adherence to guidelines was the lowest in conditions where the patient had only one indication for prophylactic antibiotics (aOR 0.36, 95% CI 0.24–0.54). The findings showed that the prevalence of prophylactic antibiotic use during delivery was moderate to high. Adherence to local guidelines was moderate. Updating the local prescribing guidelines may improve clinician adherence.

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

“…Compared with studies from LMICs, the prevalence in this study was similar to a study in Indonesia (47%) [21] and much lower than a study in India (87% for vaginal delivery and 92% for cesarean delivery) [6]. The prevalence of clinician adherence in this study was almost 80%, which was higher than in Indonesia (69%) [21]. 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].…”

“…Existing research shows that prophylactic antibiotic use during delivery was 30%, 33%, and 39% respectively in the USA [18], Denmark [19], and Canada [20]. Compared with studies from LMICs, the prevalence in this study was similar to a study in Indonesia (47%) [21] and much lower than a study in India (87% for vaginal delivery and 92% for cesarean delivery) [6]. The prevalence of clinician adherence in this study was almost 80%, which was higher than in Indonesia (69%) [21].…”

“…Improving the clinician's adherence to the antibiotic prescribing guidelines could reduce inappropriate prophylaxis antibiotic use during delivery because the guidelines were developed to limit the emergence of antibiotic resistance without compromising mother and infant health outcomes [21]. Interventions need to be multifaceted and permanent to guarantee lasting change [26,28].…”

“…The obstetric conditions for antibiotic prophylaxis, including PROM, meconium-stained amniotic fluid, and severe perineal trauma, were associated with higher antibiotic prophylaxis use and lower adherence. The main possible reason for the contradictory results is that these obstetric conditions often accompany other symptoms that need to be treated with antibiotics for therapeutic purposes [21].…”

“…However, we repeated our analysis in a healthier subpopulation without any measured indicator of the therapeutic use of antibiotics, which minimized the drawback. Second, the retrospective nature of the study design hampered the ability to explore the associated clinician's characteristics regarding adherence [21]. Besides, we cannot evaluate the temporal trends of prophylactic antibiotic use and clinician adherence in obstetrics practice in China based on the CLDS data.…”