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Antimicrobial Prophylaxis Practices for Obstetrical Infection Prevention in Alberta: A Multi-Method Study.

Nicole N Ofosu1, Jordan Tate1, Charlotte Hruczkowski1

  • 1Physician Learning Program, University of Alberta, Edmonton, AB.

Journal of Obstetrics and Gynaecology Canada : JOGC = Journal D'Obstetrique Et Gynecologie Du Canada : JOGC
|November 14, 2025
PubMed
Summary

Improving antimicrobial prophylaxis in labor and delivery is crucial. Studies show a need for better penicillin allergy documentation and appropriate antibiotic use to prevent poor health outcomes in mothers and newborns.

Keywords:
antimicrobial prophylaxiscesarean deliverygroup B Streptococcushuman-centred designobstetricalpenicillin allergysurgical site infection

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Area of Science:

  • Obstetrics and Gynecology
  • Infectious Diseases
  • Health Services Research

Background:

  • Suboptimal antimicrobial prophylaxis during labor and delivery is linked to adverse health outcomes.
  • Accurate antimicrobial prophylaxis practices are essential for preventing early-onset neonatal group B Streptococcus (GBS) disease and surgical site infections (SSI).

Purpose of the Study:

  • To examine Alberta's obstetrical antimicrobial prophylaxis practices.
  • To identify gaps and opportunities for improving clinical practices in antimicrobial prophylaxis during labor and delivery.

Main Methods:

  • Human-centered design, including patient journey mapping, was employed.
  • Health care administrative data from 13,818 deliveries were analyzed.
  • Practices for GBS and SSI prevention were assessed.

Main Results:

  • Journey mapping revealed critical needs for improved allergy documentation, penicillin allergy risk stratification, and electronic record-keeping.
  • Most patients received appropriate antimicrobial prophylaxis for GBS and SSI prevention.
  • Suboptimal use of second-line antibiotics for patients with beta-lactam allergies was observed in some cases.

Conclusions:

  • The prenatal period and hospital admission are key times for ensuring accurate allergy documentation.
  • Inappropriate penicillin allergy labeling and suboptimal antimicrobial prophylaxis administration persist.
  • Quality improvement initiatives are needed to validate allergy status and optimize antibiotic selection for penicillin-allergic patients.