The effect of antibiotic prophylaxis guidelines on surgical-site infections associated with cesarean delivery

Abstract

ObjectiveTo evaluate the effect of Norwegian antibiotic prophylaxis guidelines on rates of superficial and deep surgical-site infections (SSIs) associated with cesarean delivery (CD). MethodsA cross-sectional study was conducted that analyzed the physician-diagnosed SSIs by regimen of antibiotic prophylaxis among women who underwent planned or emergency CD at one of 42 hospitals between January 1, 2008, and December 31, 2010. The antibiotic prophylaxis regimen was verified using a hospital survey, whereas guideline compliance was assessed as part of the mandatory Norwegian Surveillance System for Healthcare-Associated Infections. ResultsData for 4498 patients were used. Hospitals that practiced antibiotic prophylaxis for all CDs (n=4) provided antibiotics more often in both emergency and planned CDs than did those that used this approach for emergency CDs only (n=33) or had no written guidelines or used prophylaxis on indication only (n=5) (P<0.001). The provision of antibiotic prophylaxis for all cases of CD was associated with markedly lowered rates of superficial SSIs among planned CDs, whereas no differences in rates of deep SSIs were observed between the guidelines in either planned or emergency CDs. ConclusionHospitals that provided antibiotic prophylaxis to all women undergoing CD reported high compliance and had reduced rates of superficial SSIs among planned CDs.