Antibiotic Prophylaxis for Cesarean Delivery Among Alabama Providers

A multicenter, randomized controlled trial has demonstrated the benefit of adding azithromycin to routine preoperative antibiotics in unscheduled cesarean deliveries (CDs) to prevent surgical site infections. We sought to describe and identify barriers to the implementation of azithromycin prophylaxis for CDs by Alabama healthcare providers.

We conducted an online, self-administered survey of obstetrics and gynecology (OB/GYN) providers in Alabama. E-mail addresses were obtained from a publicly available list. We sent an invitation to complete an anonymous online survey to 478 providers after excluding incompatible addresses and providers who previously opted out of the survey platform. After the initial survey, three reminders to complete the survey were sent. Standard questions regarding population and provider demographics were asked. We assessed timing, duration, and type of antibiotic used for scheduled cesareans and unscheduled (labor) cesareans, and the reasons for not using azithromycin for prophylaxis. Results were compared using the Student t test and χ² test as appropriate.

Of the 66 OB/GYN providers who responded to the survey, 44 (66.7%) performed CDs. Most providers (59.1%) identified as female, served a mix of urban and rural communities (54.5%), and performed deliveries at a level IV hospital (54.5%) with >2000 deliveries annually (52.3%). Most providers (77.3%) reported that an antibiotic stewardship committee supervised antibiotic use at their hospital. For unscheduled cesareans, 54.5% reported the use of azithromycin and 47.7% for scheduled cesareans. The most common reason for not currently using azithromycin was being unaware of evidence for its use (55.6%). The only factors associated with azithromycin use were the urban/rural mix of the provider's patient population (P = 0.03) and the hospital level (P < 0.01). More providers serving a primarily urban population reported azithromycin use (87.5%) compared with those serving in a rural (33.3%) or mixed (47.6%) population. In addition, 74.2% of the obstetricians who delivered in a level 3 or 4 hospital reported using azithromycin prophylaxis, whereas only 22.2% of level 1 or 2 hospital providers reported this usage.

Only 56.8% of Alabama obstetrics providers reported using azithromycin for CD, which is both effective and cost saving for prevention of surgical site infections. More needs to be done to increase awareness of these benefits.