Antibiotic Prophylaxis For Women Research Articles

Membrane stripping in group B streptococcus carriers does not impede adequate intrapartum antibiotic prophylaxis: a retrospective study.

Membrane stripping in group B streptococcus (GBS) carriers poses an increased risk of inadequate antibiotic prophylaxis, potentially due to accelerated labor, thereby potentially impacting the management of GBS colonization during delivery. We compared the adequacy of intrapartum antibiotic prophylaxis between pregnant women colonized with GBS, who underwent membrane stripping and those who did not. The study aimed to determine whether the performance of membrane stripping, by potentially shortening labor duration, increases the risk of inadequate antibiotic prophylaxis dispensation. A retrospective cohort study was conducted on GBS screen-positive women with a full-term singleton pregnancy in cephalic presentation, who were eligible for vaginal delivery. The exposed group consisted of women who underwent membrane stripping, while the unexposed group consisted of women who did not undergo membrane stripping. The primary outcome was defined as inadequate duration of antibiotic prophylaxis during labor, wherein less than 4 h of beta-lactam antibiotics were administered prior to delivery. Neonatal outcome was compared between the groups. This retrospective cohort study comprised 1,609 women, with 129 in the exposed group (stripping group) and 1,480 in the unexposed group (no stripping group). Adequate intrapartum antibiotic prophylaxis was received by 64.3% (83/129) of the exposed group, compared to 46.9% (694/1,480) of the unexposed group (p = 0.003). Membrane stripping was associated with increased odds of receiving adequate prophylaxis (OR 1.897, 95% CI 1.185-3.037, p = 0.008). After excluding women who presented to the labor ward in active labor and delivered in less than 4 h, both the exposed and unexposed groups had similarly high rates of adequate intrapartum antibiotic prophylaxis (87.5% vs. 85.8%, respectively). No significant difference was observed in adverse neonatal outcomes between the groups. The provision of membrane stripping did not impede adequate intrapartum antibiotic prophylaxis and was correlated with a higher rate of sufficient prophylaxis in comparison to non-swept patients. These observations suggest that membrane stripping can be considered a safe option for ensuring adequate antibiotic prophylaxis in women colonized with GBS.

Time to reconsider antibiotic prophylaxis in women with prolonged rupture of membranes: The trend of Enterobacteriaceae in peripartum infections.

The proportion of neonatal early-onset sepsis (EOS) by gram-negative bacteria has increased. The authors examined bacterial distribution in the amniotic membrane cultures of women with peripartum fever (PPF) and related perinatal outcomes. This retrospective study covered the period 2011 to 2019. The primary outcomes were Enterobacteriaceae-positive birth culture rates in women with PPF and the trend of ampicillin resistance. Maternal and neonatal outcomes were compared between women with group B Streptococcus (GBS) and Enterobacteriaceae-positive isolates. Bacterial distribution was also compared according to rupture of membrane (ROM) duration. Among 621 women with PPF, the positive birth culture rate was 52%. Increasing prevalences of ampicillin-resistant Enterobacteriaceae (81%) were noted. Positive birth cultures were associated with maternal bacteremia (P = 0.017) and neonatal EOS (P = 0.003). Prolonged ROM ≥18 h was associated with increased risk for Enterobacteriaceae-positive cultures, while intrapartum ampicillin and gentamicin were associated with lower risk. Enterobacteriaceae-positive compared with GBS-positive birth cultures were associated with adverse maternal and neonatal outcomes. Positive birth cultures were related to maternal bacteremia and neonatal sepsis. Adverse outcomes were more prevalent among women with Enterobacteriaceae-positive versus GBS-positive birth cultures. Prolonged ROM is a risk factor for Enterobacteriaceae-positive birth cultures among women with PPF. Antibiotic prophylaxis treatment for prolonged ROM should be reconsidered.

Incidence of postpartum infections and outcomes associated with antibiotic prophylaxis after normal vaginal birth.

Antibiotic consumption accounted for approximately 15–20% of total drug costs in Thailand. From 2017 to 2018, 24.86% of Thai women who experienced vaginal delivery during normal term labour received antibiotics for postpartum infection. The Thai national practice guidelines set the target use of antibiotic prophylaxis in women following vaginal delivery of normal term labour to be no more than 10%. This study aimed to determine the incidence of postpartum infections and the outcomes and factors associated with antibiotic prophylaxis in women following vaginal delivery. The prospective cohort study was collected from 909 eligible patients who delivered infants in 7 secondary hospitals in Chiang Mai from July 2020 to February 2021. Antibiotic prescribing data and infections in women experiencing vaginal delivery during normal term labour were collected. The incidence of postpartum infections was calculated at 2 periods, 48 h and 6 weeks, after labour. Factors associated with the prescription of antibiotic prophylaxis in vaginal delivery were analysed using multivariate logistic regression. The results showed that the prevalence of antibiotic prescribing was 12.87% in a cohort of 117 patients. Postpartum infection was reported in 3 of 117 patients with antibiotics prophylaxis and 11 of 792 without antibiotics, with no statistically significant difference (RR: 1.04, 95% CI: 0.26–4.14; p = 0.956). Postpartum hygiene self-care practices were collected in the 6th week. The results found that there were no statistical differences in mean scores for all questions on postpartum hygiene self-care practices between the infected and non-infected groups (p-value > 0.05). One of the factors associated with antibiotic prophylaxis was third to fourth degree of tear and episiotomy (OR: 7.72, 95% CI: 1.13–52.75; p = 0.037 and OR: 2.41, 95% CI: 1.24–4.70; p = 0.010, respectively). There was no significance difference in postpartum infection among patients receiving antibiotic and those who did not receive antibiotics. Third to fourth degree of tear and episiotomy were significantly factors related to antibiotic prophylaxis in women with vaginal delivery after labour. This study supports practice guidelines and helps healthcare team to be assured on the use of antibiotics in no more than 10% of women experiencing normal vaginal delivery.

Prolonged antibiotic prophylaxis in women with recurrent urinary tract infection

Long term management of women with uncomplicated recurrent urinary tract infection (UTI) is challenging. Although continuous antibiotic prophylaxis is a common form of management, its use is recommended generally for no longer than 12 months. We aimed to evaluate antibiotic resistance and tolerability in women with recurrent UTI treated with “prolonged” continuous antibiotic prophylaxis, defined as longer than 12 months. A retrospective query was performed to identify adult women referred to TTUHSC-EP Urogynecology clinic with uncomplicated recurrent UTI from 1/1/2014-12/31/2018. Recurrent UTI was defined as ≥2 symptomatic UTIs in a 6-month period or ≥3 in a 12-month period. Exclusion criteria included symptomatic prolapse, pelvic malignancy, urinary retention, voiding dysfunction with prior incontinence surgery and active pregnancy. Demographic and clinical data, including strategy and duration of treatment, was recorded for initial and subsequent clinic visits, until present time. "Resistance” was defined as resistance to prophylactic antibiotic as per urine culture in a symptomatic UTI during the prophylaxis course. Descriptive statistics were calculated. Two sample t-tests and Chi square were used for between-group comparisons. Multiple logistic regression was performed to evaluate antibiotic resistance between different duration of antibiotic prophylaxis. One hundred and eighty four women met inclusion criteria. Mean age was 62.1 ± 16. Total follow up time from initial visit was 60.3 ± 59.4 weeks. Initial strategies for prophylaxis included daily or intermittent antibiotics (60.8%), vaginal estrogen (45%), D-mannose (2.6%) and cranberry (1.5%) supplements, alone or in combination. Eventually, most patients were started on continuous antibiotic prophylaxis (84%). Twenty-seven percent (N=42) of those on continuous antibiotic prophylaxis had a “prolonged” duration. Resistance to prophylactic antibiotic occurred in 19.1% of those on "prolonged” courses vs. 5.3% of those on courses of ≦12 months (OR 3.7, 95%CI 1.14-12.18, p=0.03). For those on “prolonged” antibiotic prophylaxis, time to antibiotic resistance was 136.5 ± 92.8 weeks. On regression, factors including age, parity, prior incontinence surgery and prolapse stage did not significantly increase risk for resistance, with exception of thyroid disease (OR 4.8 95%CI 1.43-16.01, p=0.01). There were no cases of discontinuation of continuous prophylaxis due to abnormalities in liver or renal function, or intolerance to antibiotic. In women with recurrent UTI, continuous antibiotic prophylaxis longer than 12 months was associated with an almost four-fold increased risk for resistance to the prophylactic antibiotic. However, the mean time for resistance was ≧2.5 years, and prophylaxis was well tolerated. Prolonged antibiotic prophylaxis seems acceptable with appropriate monitoring and counseling on the risk of resistance.

Need for Intrapartum Antibiotic Prophylaxis in Women with Prior History of Group B Streptococcus Carriage

The incidence of early onset neonatal GBS(EOGBS) disease in the UK and Ireland is 0.57/1000 births. Intrapartum antibiotic prophylaxis (IAP) reduces the risk. Previous colonisation is associated with 50% carriage in the current pregnancy. In these women, RCOG recommends IAP with a history of neonatal infection, otherwise offering the option of screening at 35-37 weeks. In Ireland, there is no national consensus on IAP in prior GBS colonisation. Currently at University Hospital Waterford (UHW), all women with prior GBS colonisation receive IAP. Studies examining the use of point-of-care testing have shown reduction in the use of IAP and EOGBS rates. We aimed to examine the screening and IAP administration in maternal prior GBS colonisation and the incidence of GBS in this cohort in UHW. Data was collected retrospectively from laboratory, medical records and electronic patient manager systems. Women who received IAP between 1stJuly 2020 and 31stDecember 2020 were identified. Women who received IAP for current and prior GBS colonisation were included. Women who received IAP for preterm labour, preterm prelabour rupture of membranes and pyrexia in labour were excluded. Ninety-two women with current or prior GBS colonisation received IAP, of which only 15(16.30%) were current and 77(83.69%) were prior GBS colonisation. In women with prior GBS colonisation, 49(63.63%) were screened, 3/49(6.12%) were positive, 28 were not screened. Seventy-eight (84.78%) received benzyl-penicillin. Six (6.52%) received clindamycin. Twenty-two (23.91%) babies were admitted to the Neonatal Unit, however, only one cultured positive for gram-positive cocci. The incidence of EOGBS in this cohort is low. A risk-based approach or point-of-care testing should be considered to reduce unnecessary IAP administration.

Meta-analysis on prevalence of vaginal group B streptococcus colonization and preterm births in India

Objective Preterm birth is a major cause of neonatal morbidity and mortality. Vaginal colonization of Group B Streptococci (GBS) is associated with increased risk of preterm birth. However, the association of GBS colonization and preterm births in the Indian context remains an unrecognized problem. Data sources Data was collected using various online search tools from 36 (1981–2019) Indian studies comprising 9778 cases. Method of study selection Studies reporting the prevalence of GBS colonization in the Indian population were included. Tabulation, Integration, and Results The prevalence of GBS colonization in pregnant Indian women was estimated to be 7.8% (763/9778) with wide heterogeneity across studies. The prevalence of GBS was 7.4% when culture methods were used and 11.6% with use of immunological methods. The detection rate of GBS almost doubled when enrichment was used in the culture method (8.1 vs. 5%). The risk of preterm delivery was higher (OR 7.9) among women with GBS colonization as compared to those without GBS. Conclusions As compared to the western population, there is low prevalence of GBS colonization among Indian pregnant women; however, the risk of preterm births with GBS colonization is higher. There is a need to implement a universal GBS screening program prior to intrapartum antibiotic prophylaxis in women experiencing preterm births.

Long-term efficacy of intravesical instillation of hyaluronic acid/chondroitin sulfate in recurrent bacterial cystitis: 36 months' follow-up

Purpose of Investigation: To compare the efficacy and safety of intravesical instillation of hyaluronic acid/chondroitin sulfate with conventional long-term antibiotic prophylaxis in women with recurrent bacterial cystitis. Materials and Methods: In this analysis of a prospective study, where women with recurrent bacterial cystitis were randomised to intravesical hyaluronic acid 800 mg/chondroitin sulfate 1,000 mg (group 1) or long-term antibiotic prophylaxis (group 2 – control group), patients in group 1 were evaluated 36 months after treatment. Outcomes included cystitis recurrence, subjective pain symptoms based on a visual analogue scale (VAS), three-day voiding, pelvic pain and urgency/frequency symptoms (PUF scale), sexual function questionnaire, quality of life based on King’s Health Questionnaire (KHQ), maximum cystometric capacity (MCC), and adverse events. Results: Twelve women (mean ± standard deviation 59.3 ± 13.9 years old) underwent follow-up at 36 months after treatment. There were improvements in all efficacy evaluations at 36 months’ follow-up, with significantly favourable mean changes from baseline in cystitis frequency (–5.4 episodes/year; p p = 0.002), urinary VAS (–6.7 points; p p p p p Conclusions: Intravesical hyaluronic acid/chondroitin sulfate significantly reduced cystitis recurrence and associated symptoms and was well tolerated in women with recurrent bacterial cystitis at 36 months’ after treatment.

The effect of antibiotic prophylaxis for acute pelvic inflammatory disease after hysterosalpingography: a retrospective cohort study

Aims: Concerns about acute pelvic inflammatory disease (PID) after hysterosalpingography (HSG) have been raised since 1980. However, the effectiveness of prophylactic antibiotics remains unclear. This study investigated the effect of antibiotic prophylaxis in women undergoing HSG.Methods: Women undergoing HSG between 2000 and 2012 were screened from the Taiwan National Health Insurance Research Database for eligibility. The prophylactic cohort included patients using any antibiotics of 1st-generation cephalosporins, doxycycline, clindamycin, and metronidazole, within 7 days before HSG (n = 3257). Patients not using any antibiotics were registered as the non-prophylactic cohort (n = 4662). An unconditional logistic regression model was applied to calculate the odds ratio (OR) and 95% confidence interval (CI) of acute PID after HSG associated with prophylactic antibiotics.Results: The cumulative incidences of acute PID after HSG were 0.46% and 1.42% in the prophylactic and non-prophylactic cohorts, respectively. Prophylactic patients had a significantly reduced estimated relative risk of acute PID compared with non-prophylactic patients (adjusted OR = 0.33, 95% CI = 0.19–0.58; p = .001). Doxycycline users had the lowest adjusted OR of 0.20 (95% CI = 0.04–0.81; p = .02), followed by users of 1st-generation cephalosporins (adjusted OR = 0.35, 95% CI = 0.18–0.68; p = .002). Multivariate sub-group analysis verified this protective effect for almost all sub-groups of prophylactic patients.Conclusions: Antibiotic prophylaxis is associated with a decreased estimated relative risk of acute PID in HSG patients. Doxycycline and 1st-generation cephalosporins may be effective prophylactic regimens for HSG.

Incidence of Bacteriuria after Urodynamic Study with or without Antibiotic Prophylaxis in Women with Urinary Incontinence.

Introduction The presence of bacteria in urine is called bacteriuria, which may be symptomatic or asymptomatic. The manipulation of the urinary tract during urodynamic study (UDS), which is an invasive procedure, can result in urinary tract infection (UTI). Studies on the use of prophylactic antibiotics for UDSs are contradictory. Some investigators concluded that they were valuable and others did not. The objective of this study is to evaluate the efficacy of antibiotic prophylaxis before UDS. This is a placebo-control randomized double-blind study. Methods Two-hundred and seventeen women affected by urinary incontinence were eligible for this study. All patients had presented negative urine culture previous to the UDS. They were randomized in four groups: group A received placebo, group B received 500 mg of levofloxacin, group C received 80 mg trimethoprim and 400 mg sulfamethoxazole and group D received 100 mg of nitrofurantoin. A urine culture was performed 14 days after the UDS. Results We observed asymptomatic bacteriuria after the UDS in five patients in group A, one in group B, one in group C and one in group D. Only one patient on group A had symptomatic bacteriuria. We didn't observe statistical difference between the groups. When we recategorized the patients in two groups, the incidence of bacteriuria was significantly higher in the placebo group compared with the antibiotic group. Conclusion The conclusion is that antibiotic prophylaxis before the UDS did not reduce the incidence of UTI in women within the target population.

Antibiotic prophylaxis for elective hysterectomy.

Antibiotic prophylaxis for elective hysterectomy.

Antimicrobial Prophylaxis for Women with First Trimester Vaginal Bleeding Could Reduce the Rate of Miscarriage

This is a prospective study conducted to examine the possible benefit of antibiotic prophylaxis in reducing the symptoms of threatened miscarriage as well as decreasing the rate of progression into spontaneous miscarriage in women with first trimester vaginal bleeding. This study was conducted at Al Thawra General Hospital over a year (from Jan. to Dec 2016). Ninety-two women with threatened miscarriage during the first trimester were included (case group) and compared to 90 pregnant women without vaginal bleeding with similar parity and gestational age. Amoxicillin-clavulanate drug was given for all cases of the study group during vaginal bleeding. Both groups were monitored up to 28 weeks gestational age. Among 92 women with threatened miscarriage, only three cases (3.2%) had spontaneous loss (P < 0.001). Vaginal bleeding was significantly relieved within 3 days of antibiotic administration (P < 0.00). Results of this study give evidence that antibiotic prophylaxis for women with threatened miscarriage reduces the amount and duration of vaginal bleeding, and decreases the rate of progression into spontaneous miscarriage.

Vaginal Probiotic Administration in the Management of Preterm Premature Rupture of Membranes

Objective: To examine the influence of vaginal probiotic administration as an adjunct to standard antibiotic treatment on perinatal outcome in women with preterm premature rupture of membranes (PPROM). Materials and Methods: This was a prospective randomized trial of cases with PPROM (24-34 weeks) that were admitted to our department between 2011 and 2015. Forty-nine cases received vaginal probiotics for 10 days in combination with antibiotic prophylaxis and were compared to 57 others that received only antibiotics for the same time period. Results: The mean gestational age at birth (35.49 vs. 32.53 weeks), the mean duration of the latency period (5.60 vs. 2.48 weeks), and the mean birth weight (2,439.08 vs. 2,004.81 g) were significantly higher in the study group in comparison to the controls. Moreover, the neonates of the study group had a lower chance to enter the neonatal intensive care unit or the neonatal special care unit, shorter total hospitalization time, and lower need for oxygen administration and mechanical ventilation, as well as lower length of oxygen administration. Conclusions: Vaginal probiotics as an adjunct to antibiotic prophylaxis in women with PPROM prolonged the latency period and improved the perinatal outcome.

Antibiotic prophylaxis for term or near-term premature rupture of membranes: metaanalysis of randomized trials

The objective of the study was to evaluate the efficacy of antibiotic prophylaxis in women with term or near-term premature rupture of membranes. Searches were performed in MEDLINE, OVID, Scopus, ClinicalTrials.gov, the PROSPERO International Prospective Register of Systematic Reviews, EMBASE, ScienceDirect.com, MEDSCAPE, and the Cochrane Central Register of Controlled Trials with the use of a combination of key words and text words related to antibiotics, premature rupture of membranes, term, and trials from inception of each database to September 2014. We included all randomized trials of singleton gestations with premature rupture of membranes at 36 weeks or more, who were randomized to antibiotic prophylaxis or control (either placebo or no treatment). The primary outcomes included maternal chorioamnionitis and neonatal sepsis. A subgroup analysis on studies with latency more than 12 hours was planned. Before data extraction, the review was registered with the PROSPERO International Prospective Register of Systematic Reviews (registration number CRD42014013928). The metaanalysis was performed following the Preferred Reporting Item for Systematic Reviews and Meta-analyses statement. Women who received antibiotics had the same rate of chorioamnionitis (2.7% vs 3.7%; relative risk [RR], 0.73, 95% confidence interval [CI], 0.48-1.12), endometritis (0.4% vs 0.9%; RR, 0.44, 95% CI, 0.18-1.10), maternal infection (3.1% vs 4.6%; RR, 0.48, 95% CI, 0.19-1.21), and neonatal sepsis (1.0% vs 1.4%; RR, 0.69, 95% CI, 0.34-1.39). In the planned subgroup analysis, women with latency longer than 12 hours, who received antibiotics, had a lower rate of chorioamnionitis (2.9% vs 6.1%; RR, 0.49, 95% CI, 0.27-0.91) and endometritis (0% vs 2.2%; RR, 0.12, 95% CI, 0.02-0.62) compared with the control group. Antibiotic prophylaxis for term or near-term premature rupture of membranes is not associated with any benefits in either maternal or neonatal outcomes. In women with latency longer than 12 hours, prophylactic antibiotics are associated with significantly lower rates of chorioamnionitis by 51% and endometritis by 88%.

Cervical dilatation thresholds for initiation of group B streptococcus antibiotic prophylaxis for women with spontaneous preterm labor

Objective: To determine the optimal time for initiating group B streptococcus (GBS) antibiotic prophylaxis for women in spontaneous preterm labor.Methods: In total, 227 women delivering singleton infants after presenting with spontaneous preterm labor and intact membranes at 24 0/7–36 6/7 weeks were evaluated, as well as 150 undelivered women with threatened preterm labor during the same time period. The date and time of each cervical examination throughout labor were recorded. We calculated the percentages who would have correctly received at least 4 h of GBS prophylaxis if antibiotics were routinely initiated for various cervical dilatation thresholds during labor, as well as the percentage of undelivered women who would have received unnecessary antibiotic exposure at each cervical dilatation cutoff.Results: Delaying antibiotics until cervical dilatation reached 2 cm or greater would have resulted in 62.1% receiving four or more hours of antibiotics, compared to 66.5% if antibiotics were started on all women at admission (p = 0.33), while significantly reducing unnecessary antibiotic exposure in undelivered women from 100% to 62.0% (p < 0.001). The 2-cm threshold was applicable regardless of gestational age period or prior vaginal delivery ≥ 20 weeks.Conclusions: GBS antibiotic prophylaxis may reasonably be withheld for women with suspected preterm labor until the cervix reaches 2 cm or greater at any time during labor.

529: Poor compliance with recommendations for perioperative antibiotic prophylaxis in women undergoing cesarean delivery

529: Poor compliance with recommendations for perioperative antibiotic prophylaxis in women undergoing cesarean delivery

Use of Guideline-Based Antibiotic Prophylaxis in Women Undergoing Gynecologic Surgery

To examine guideline-based use of prophylactic antibiotics in patients who underwent gynecologic surgery. We identified women who underwent gynecologic surgery between 2003 and 2010. Procedures were stratified as antibiotic-appropriate (abdominal, vaginal, or laparoscopically assisted vaginal hysterectomy) or antibiotic-inappropriate (oophorectomy, cystectomy, tubal ligation, dilation and curettage, myomectomy, and tubal ligation). Antibiotic use was examined using hierarchical regression models. Among 545,332 women who underwent procedures for which antibiotics were recommended, 87.1% received appropriate antibiotic prophylaxis, 2.3% received nonguideline-recommended antibiotics, and 10.6% received no prophylaxis. Use of antibiotics increased from 88.0% in 2003 to 90.7% in 2010 (P<.001). Among 491,071, who underwent operations for which antibiotics were not recommended, antibiotics were administered to 197,226 (40.2%) women. Use of nonguideline-based antibiotics also increased over time from 33.4% in 2003 to 43.7% in 2010 (P<.001). Year of diagnosis, surgeon and hospital procedural volume, and area of residence were the strongest predictors of guideline-based and nonguideline-based antibiotic use. Although use of antibiotics is high for women who should receive antibiotics, antibiotics are increasingly being administered to women for whom the drugs are of unproven benefit. : III.

Concerning the timing of antibiotic administration in women undergoing caesarean section: a systematic review and meta-analysis

ObjectiveTo assess the effects on maternal infectious morbidity and neonatal outcomes of the timing of antibiotic prophylaxis in women undergoing caesarean section. A recent National Institute for Health and Clinical...

519: Optimizing the timing of intrapartum GBS antibiotic prophylaxis for women with spontaneous preterm labor

519: Optimizing the timing of intrapartum GBS antibiotic prophylaxis for women with spontaneous preterm labor

Antibiotic prophylaxis for hysterectomy and cesarean section: Amoxicillin-clavulanic acid versus cefazolin

Objective To compare amoxycillin-clavulanic acid with cefazolin as short term antibiotic prophylaxis in women undergoing hysterectomy and elective cesarean section.

Empowering surgical nurses improves compliance rates for antibiotic prophylaxis after caesarean birth

Empowering surgical nurses improves compliance rates for antibiotic prophylaxis after caesarean birth. This paper is a report of a study of the effect of empowering surgical nurses to ensure that patients receive antibiotic prophylaxis after caesarean birth. Despite the consensus that single dose antibiotic prophylaxis is beneficial for women have either elective or non-elective caesarean delivery, hospitals need methods to increase compliance rates. In a study in Israel in 2007 surgical nurses were empowered to ensure that a single dose of cefazolin was given to the mother after cord clamping. A computerized system was used to identify women having caesarean births, cultures sent and culture results. Compliance was determined by chart review. Rates of compliance, suspected wound infections, and confirmed wound infections in 2007 were compared to rates in 2006 before the policy change. Relative risks were calculated dividing 2007 rates by those in 2006, and 95% confidence intervals were calculated using Taylor's series that does not assume a normal distribution. Statistical significance was assessed using the chi-square test. The compliance rate was increased from 25% in 2006 to 100% in 2007 (chi-square test, P < 0.001). Suspected wound infection rates decreased from 16.8% (186/1104) to 12.6% (137/1089) after the intervention (relative risk 0.75, 95% confidence interval, 0.61-0.92). Surgical nurses can ensure universal compliance for antibiotic prophylaxis in women after caesarean birth, leading to a reduction in wound infections.