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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.
Highlights
Bacterial infection during labor and delivery is one of the leading causes of maternal and neonatal mortality worldwide, accounting for about one-tenth of the global burden of maternal and neonatal deaths [1,2]
Compared to other studies from low- to middle-income countries, the current findings on prevalence were higher than those reported from Ghana, at 28%, but were much lower than those found in another study at a tertiary level hospital in India, where 994 of 1077 (92.3%) deliveries during the 2008–2010 period presented with indications that required the prescription of prophylactic antibiotics during and after delivery [16,17]
This study found that, among the conditions recommended for prophylactic antibiotic administration, only C-sections, antepartum hemorrhage, and premature rupture of membranes (PROM) were persistently associated with an increased risk of prophylactic antibiotic use
Summary
Bacterial infection during labor and delivery is one of the leading causes of maternal and neonatal mortality worldwide, accounting for about one-tenth of the global burden of maternal and neonatal deaths [1,2]. Neonatal sepsis is a major cause of neonatal mortality and accounts for 13 per cent of newborn deaths [7]. Infection is one of the three leading causes of maternal death [8,9]. Reduction of bacterial infections is typically attempted by the prescription of prophylactic antibiotics during labor and delivery as a routine practice. Studies have shown that the use of antibiotics has reduced maternal infections and has improved neonatal outcomes. The benefit of prophylactic antibiotics in reducing infection incidence in women who have undergone a C-section has been proven [12]. Prophylactic antibiotic use for the premature rupture of membranes (PROM)
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