Abstract
BackgroundPreoperative 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.MethodsA 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.ResultsThe 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.ConclusionsSurgical 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.
Highlights
Caesarean section is one of the most frequent obstetric surgeries in the world and its use has increased exponentially in recent years [1]; it allows the life of the mother and/or child to be saved in certain situations, but it is not without risk [2].Complications of caesarean delivery include surgical site infections (SSIs), which are among the leading causes of maternal death [3]
As in other non-infected surgical acts, antibiotic prophylaxis is recommended for all caesarean deliveries unless the patient is already receiving an antibiotic regimen for another existing infectious entity [9, 11, 13,14,15,16]
Patients who suffered a loss of blood greater than 1.5 L or who had prolonged surgery, received prophylaxis for approximately 7 days, just like the rest of patients, which is in contradiction to what was stated in the literature [11, 14, 15]
Summary
Caesarean section is one of the most frequent obstetric surgeries in the world and its use has increased exponentially in recent years [1]; it allows the life of the mother and/or child to be saved in certain situations, but it is not without risk [2].Complications of caesarean delivery include surgical site infections (SSIs), which are among the leading causes of maternal death [3]. Caesarean section is one of the most frequent obstetric surgeries in the world and its use has increased exponentially in recent years [1]; it allows the life of the mother and/or child to be saved in certain situations, but it is not without risk [2]. Appropriate preoperative antibiotic prophylaxis (PAP), defined by the World Health Organization (WHO) as "administering an effective antimicrobial agent prior to exposure to contamination during surgery", is necessary to prevent SSI [5]. 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
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