Antibiotic Prophylaxis for Prevention of Postpartum Perineal Wound Complications

Duggal, Neena; Mercado, Celia; Daniels, Kay; Bujor, Alexandra; Caughey, Aaron B.; El‐Sayed, Yasser Y.

doi:10.1097/aog.0b013e31816de8ad

Cited by 157 publications

(14 citation statements)

References 22 publications

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“…A Cochrane review on antibiotic prophylaxis during OASI repair identified only one randomized control trial (RCT) [ 24 , 25 ]. Either the RCT or the Cochrane review were cited as a reference for prophylactic antibiotics at the time of repair by seven of the ten guidelines that recommended this.…”

Section: Discussionmentioning

confidence: 99%

Review of available national guidelines for obstetric anal sphincter injury

Roper

Amber²,

Wan

et al. 2020

Int Urogynecol J

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Introduction and hypothesis Obstetric anal sphincter injuries (OASIs) are the most severe form of perineal trauma with potentially devastating effects on a mother’s quality of life. There are various national guidelines available for their management. The aim of this study was to review and compare recommendations from published national guidelines regarding management and prevention of OASI. Methods We searched the PUBMED, EMBASE, MEDLINE, CINAHL and COCHRANE databases from January 2008 till October 2019 using relevant Medical Subject Headings (MeSH), including all subheadings. The guideline characteristics were mapped and methodological quality assessed with the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool by three independent reviewers. To compare the methodological quality of the guidelines, the interpretation of the six domain scores were taken into consideration. By consensus of the authors, a score of 70% was taken as a cut-off, and scores above this were considered ‘high quality’. Results Thirteen national guidelines on perineal trauma were included and analysed. Nine of these were specific to OASI. There is wide variation in methodological quality and evidence used for recommendations. AGREE scores for overall guideline assessment were > 70% in eight of the guidelines, with Australia-Queensland, Canada, the UK and USA scoring highest. Conclusions The wide variation in methodological quality and evidence used for recommendations suggests that there is a need for an agreed international guideline. This will enable healthcare practitioners to follow the same recommendations, with the most recent evidence, and provide evidence-based care to all women globally.

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Section: Discussionmentioning

confidence: 99%

Review of available national guidelines for obstetric anal sphincter injury

Roper

Amber²,

Wan

et al. 2020

Int Urogynecol J

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“…Evidence demonstrate that surgical antibiotic prophylaxis; defined as the administration of antibiotic prior to incision with the ultimate goal of preventing infection after surgery, significantly reduce the incidence of SSIs [8, 9]. However, the efficacy of surgical antibiotic prophylaxis depends on the following factors: choice of antibiotic, time of administration, dose, re-dosing (in prolong surgery) and duration of administration [10].…”

Section: Introductionmentioning

confidence: 99%

Impact of pharmacist-led antibiotic stewardship interventions on compliance with surgical antibiotic prophylaxis in obstetric and gynecologic surgeries in Nigeria

2019

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Background Inappropriate and excessive use of surgical antibiotic prophylaxis are associated with the emergence of antibiotic resistance. Antibiotic prophylaxis malpractices are common in obstetrics and gynecology settings and antibiotic stewardship is used to correct such malpractice. Objective To evaluate the impact of antibiotic stewardship interventions on compliance with surgical antibiotic prophylaxis practice in obstetrics and gynecology surgeries. Method A prospective pre- and post-intervention study was conducted in two tertiary hospitals between May and December 2016. The duration of the each period was 3 months. Antibiotic stewardship interventions including development of a protocol, educational meeting and audit and feedback were implemented. Data were collected using the patient records and analyzed with SPSS version 23. Results A total of 226 and 238 surgical procedures were included in the pre- and post-intervention periods respectively. Age, length of stay and estimated blood loss were similar between the two groups. However, specialty and surgical procedures varied significantly. There was a significant increase in compliance with timing (from 14.2% to 43.3%) and duration (from 0% to 21.8%) of surgical antibiotic prophylaxis after the interventions. The interventions significantly reduced the prescription of third generation cephalosporin (-8.6%), redundant antibiotic (-19.1%), antibiotic utilization (-3.8 DDD/procedure) and cost of antibiotic prophylaxis (-$4.2/procedure). There was no significant difference in the rate of surgical site infection between the two periods. Post-intervention group (OR: 5.60; 95% CI: 3.31–9.47), elective surgery (OR: 4.62; 95% CI: 2.51–8.47) and hospital attended (OR: 9.89; 95% CI: 5.66–17.26) were significant predictors of compliance with timing while elective surgery (OR: 12.49; 95% CI: 2.85–54.71) and compliance with timing (OR: 58.55; 95% CI: 12.66–270.75) were significantly associated with compliance to duration of surgical antibiotic prophylaxis. Conclusion The interventions improve compliance with surgical antibiotic prophylaxis and reduce antibiotic utilization and cost. However, there is opportunity for further improvement, particularly in non-elective surgical procedures.

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“… 13 Intra-operative second-generation cephalosporins have been shown to significantly reduce perineal wound infections from 24.2% to 8.2%. 14 We recommended 24–48 hours of cefazolin and metronidazole. The rates of compliance with intra- and postoperative antibiotics were all improved after implementation of the new guideline.…”

Section: Discussionmentioning

confidence: 99%

The effect of implementing a new guideline and operative pro forma on the detection and management of third- and fourth-degree perineal tears

Cornell¹,

Souza²,

Tacey³

et al. 2016

IJWH

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BackgroundObstetric anal sphincter injury (OASI) is a serious complication of vaginal births, resulting in possible long-term consequences such as incontinence and pain. Adequate detection and management of these injuries is vital in minimizing the impact they have on women.AimTo assess the rates of detection, management, and outcomes of OASI before and after the implementation of a new clinical practice guideline and operative pro forma.Materials and methodsA 12-month audit of the incidence, management, and outcomes of OASI was conducted in 2009. An operative pro forma and practice guideline were implemented in 2010 followed by a further audit undertaken between 2010 and 2012. Statistical analysis was performed to determine any significant change in practice.ResultsThe distribution of risk factors for OASI including primiparity, birthweight, and type of vaginal delivery was similar between the two audited groups. After implementation of the pro forma, the reported incidence of OASI increased from 1.62% to 3.1% (P=0.004). Significant changes in management included an increase in the use of recommended suture material (48% vs 80%, P=0.002), postoperative antibiotics (78% vs 99%, P=0.001), postoperative catheterization (52% vs 90%, P<0.001), and inpatient physiotherapy consultations (44% vs 97%, P=<0.001). An increase was seen in women attending their 6-week follow-up appointment (33% vs 54% P=0.058); however, this was just below the level of statistical significance.ConclusionThe introduction of the new pro forma and guideline resulted in an increase in the reported incidence of OASI, improved management, and follow-up of patients.

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Antibiotic Prophylaxis for Prevention of Postpartum Perineal Wound Complications

Abstract: I.

Cited by 157 publications

References 22 publications

Review of available national guidelines for obstetric anal sphincter injury

Review of available national guidelines for obstetric anal sphincter injury

Impact of pharmacist-led antibiotic stewardship interventions on compliance with surgical antibiotic prophylaxis in obstetric and gynecologic surgeries in Nigeria

The effect of implementing a new guideline and operative pro forma on the detection and management of third- and fourth-degree perineal tears

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