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Published on: August 30, 2018
Are local clinical guidelines useful in promoting rational use of antibiotic prophylaxis in caesarean delivery?
Svetlana Ristić1, Branislava Miljković, Sandra Vezmar
1Clinic of Gynaecology and Obstetrics Narodni front, Medical School, University of Belgrade, Belgrade, Serbia.
Insights
Local clinical guidelines for antibiotic prophylaxis in caesarean delivery changed prescribing patterns, reducing costs by 47%. Antibiotic use shifted from newer to older agents, with no significant impact on wound infections or hospital stay.
Area of Science:
- Obstetrics and Gynecology
- Infectious Diseases
- Pharmacology
Background:
- Antibiotic prophylaxis is crucial in caesarean delivery to prevent surgical site infections.
- Local clinical guidelines aim to optimize antibiotic use for efficacy and cost-effectiveness.
Purpose of the Study:
- To evaluate the impact of local clinical guidelines on antibiotic prophylaxis prescribing patterns in caesarean sections.
- To assess changes in treatment outcomes, including wound infections and hospital stay, following guideline implementation.
Main Methods:
- A quantitative retrospective analysis was conducted comparing antibiotic use before and after guideline implementation.
- Data from 261 patients pre-guidelines and 281 patients post-guidelines were analyzed.
- Drug utilization costs, duration of hospital stay, and wound infection rates were the primary outcome measures.
Main Results:
- Significant shifts in antibiotic prescribing patterns were observed, with decreased use of ceftriaxone, amikacin, and metronidazole.
- The utilization of older antibiotics like gentamicin, cefuroxime, cefazolin, and ampicillin increased.
- Total costs for prophylactic antibiotics decreased by 47%, while wound infection rates and hospital stay duration remained unchanged.
Conclusions:
- Local clinical guidelines effectively altered antibiotic prescribing for caesarean sections, promoting the use of older, cost-effective agents.
- The implemented guidelines achieved cost savings without compromising patient outcomes like wound infection rates or hospital stay duration.
Objectives:
To identify changes in prescribing patterns of antibiotic prophylaxis in caesarean delivery after introduction of local clinical guidelines. To identify changes in outcomes of prescribing antibiotics following the implementation of local clinical guidelines on antibiotic prophylaxis.
Setting:
University of Belgrade, Medical School, Clinic of Gynaecology and Obstetrics "Narodni front" Belgrade, Serbia.
Method:
A quantitative retrospective analysis of antibiotic use before (January-June 2005), and following (January-June 2006) implementation of guidelines on antibiotic prophylaxis in two wards. Patients who underwent caesarean section prior to (261) and following (281) introduction of local guidelines, participated in this study.
Main Outcome Measures:
Drug utilization cost presented as the number of DDD/100 bed days/eur, the average duration of hospital stay, number of wound infections.
Results:
There was a significant change in prescribing patterns of antibiotic prophylaxis in caesarean section following introduction of local guidelines. The use of ceftriaxone, amikacin and metronidazole decreased (57.47% vs. 11.74%; 9.19% vs. 4.27%; 61.69% vs. 46.26%, respectively). On the other hand, the use of "older" antibiotics such as gentamicin, cefuroxime, cefazolin and ampicillin increased (14.56% vs. 29.18%; 9.2% vs. 17.44%; 9.58% vs. 45.2% and 0% vs. 3.9%, respectively). DDD/100 bed days/eur analysis revealed a 47% decrease of total cost for prophylactic antibiotic treatment in caesarean section following local guideline implementation. In contrast, rate of wound infections and duration of hospital stay were not significantly different in both groups.
Conclusion:
In an attempt to ensure cost-effective prophylactic use of antibiotics in caesarean delivery, local clinical guidelines were introduced. They resulted in changes in prescribing patterns of antibiotics. There was a significant decrease in use of 'third' generation of cephalosporin's whereas the use of "older" antibiotics with proven efficacy and safety increased. In contrast, there was no significant change in treatment outcomes such as wound infection and average hospital stay.
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