Rationalising antibiotic use after low-risk vaginal deliveries in a hospital setting in India

Abstract

BackgroundIn 2017, a postoperative multidrug resistant case of urinary tract infection made obstetricians at Sitaram Bhartia Institute of Science and Research introspect the antibiotic usage in labouring mothers. Random case file reviews indicated overuse and variability of practice among care providers. This prompted us to explore ways to rationalise antibiotic use.MethodsA multidisciplinary team of obstetricians, paediatricians and quality officers was formed to run this improvement initiative at a private hospital facility in India. Review of literature advocated formulating a departmental antibiotic policy. Creating this policy and implementing it using improvement methodology helped us rationalise antibiotic usage.InterventionsWe aimed to reduce the use of antibiotics from 42% to less than 10% in uncomplicated vaginal deliveries. We tested a series of sequential interventions using the improvement methodology of Plan–Do–Study–Act (PDSA) cycles, an approach recommended by the Institute for Healthcare Improvement. Learning from the PDSA cycle of the previous intervention helped decide the subsequent change ideas. The interventions included creation of a departmental antibiotic policy, staff engagement, and modification in documentation, concept of dual responsibility and team huddles as feedback opportunities. Information was analysed to understand the progress and improvement with change ideas.ResultsBackground analysis revealed that antibiotic usage ranged from 24% to 69% and average rate of antibiotic prophylaxis was high (42.28%) in low-risk uncomplicated vaginal deliveries. The sequential changes resulted in reduction in antibiotic usage to 10% in the target population by 4 months. Sustained improvement was noted in the following months.ConclusionWe succeeded in implementing a departmental antibiotic policy aligning it with existing international guidelines and our local challenges. Antibiotic stewardship was one of the first major steps in our journey to avoid multidrug-resistant infections. Sustaining outcomes will involve continuous feedback to ensure engagement of all stakeholders in a hospital setting.

Antibiotic Prescribing in Connection to Childbirth: An Observational Study in Two Districts in Lao PDR

“…In that study, the investigation was based on interviews with only 69 mothers, and no data were extracted from medical charts; therefore, the antibiotic prescription rate might have been underestimated. A study in India also revealed a high usage of antibiotics for low-risk vaginal deliveries (24-69%), and the decision of starting antibiotic was at the primary care provider's discretion and not based on any standard departmental protocol [16], which was similar to what was found in our study. In the uncomplicated vaginal delivery group, we also found that 62.1% of women in district hospitals received amoxicillin but 66.7% of women in health centers received ampicillin, and more women in health centers received antibiotics via the intramuscular route of administration.…”