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Improving compliance with surgical antibiotic prophylaxis for elective cesarean section through antimicrobial stewardship

  • At: PPR SIG 2021 (2021)
  • Type: Digital
  • Co-author(s): Usman Abubakar, Syed Azhar Syed Sulaiman, Adebiyi Gbadebo Adesiyun
  • Abstract:


    Inappropriate use of surgical antibiotic prophylaxis (SAP) for cesarean section can contribute to the emergence and spread of antibiotic resistance. There is paucity of data describing the impact of antibiotic stewardship interventions on compliance with SAP.


    To evaluate the impact of pharmacist-led antibiotic stewardship interventions on compliance with SAP in women who had elective cesarean section.


    This was a prospective pre- and post-intervention study conducted in two tertiary hospitals in Northern Nigeria between May and December 2016. Women who had elective cesarean section with no infection at the time of incision were included. Antibiotic stewardship interventions implemented include educational meeting with obstetricians, development of a local SAP protocol, and feedback to obstetricians. Compliance with timing and duration of SAP was measured in the pre- and post-intervention periods.


    A total of 70 and 73 women were included in the pre- and post-intervention group, respectively. Patient characteristics were comparable except the age of the patients. There was a significant increase in compliance with timing (from 7.1% to 58.9%) and duration (from 0.0% to 45.2%) of SAP, and a decrease in the rate of redundant anaerobic antibiotic combination (from 88.6% to 45.2%) after the interventions. The prescription of amoxicillin-clavulanic acid combination and metronidazole was reduced by 13.3% (P = 0.04) and 38.1% (P < 0.001) during the post-intervention period, respectively. The rate of surgical site infection was comparable in the two group. Antibiotic consumption (-5.4 Defined Daily Dose/procedure) and expenditure (- 8.9 USD/procedure) were also reduced in the post-intervention period (P < 0.001).


    Antibiotic stewardship interventions improve compliance with timing and duration of SAP; reduce the use of redundant antibiotic combination, antibiotic consumption and expenditure among women who undergo elective cesarean section.

Last update 4 October 2019

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