Original Article

CME Article: Adherence to Guideline-Based Antibiotic Prophylaxis in Gynecology among Alabama Providers

Authors: Tera Howard, MD, MPH, Alan Tita, MD, PhD, Lisa Dimperio, MS, Lorie Harper, MD

Abstract

Objectives: Surgical site infection (SSI) is a preventable cause of postoperative morbidity. The appropriate use of perioperative antibiotics for prevention of SSIs is a well-established quality metric. Little is known about the adherence to guidelines-based antibiotic prophylaxis among Alabama obstetricians and gynecologists. Our aims were to determine their adherence to guidelines-based antibiotic prophylaxis and identify the factors that are predictive of nonadherence.

Methods: Online, self-administered survey of Alabama obstetricians and gynecologists.

Results: Providers reported not providing the indicated antibiotics and/or giving nonindicated antibiotics in almost all surgical scenarios. The exceptions included hysterectomies, in which almost all (96%) providers routinely gave indicated antibiotics. No providers reported giving antibiotics during intrauterine device placement or endometrial biopsies, which is appropriate. The only factor predictive of inappropriate antibiotic use was the absence of a standing antibiotic protocol.

Conclusions: Alabama gynecologic surgeons can and should improve their compliance with guidelines-based antibiotic prophylaxis. More research is needed to determine which interventions would improve adherence in this provider population; our study suggests that the implementation of a standing antibiotic protocol may be a reasonable first step.

 
Posted in: Obstetrics and Gynecology69

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References

1. Steiner HL, Strand EA. Surgical-site infection in gynecologic surgery: pathophysiology and prevention. Am J Obstet Gynecol 2017;217:121-128.
2. Ayeleke RO, Mourad S, Majoribanks J, et al. Antibiotic prophylaxis for elective hysterectomy. Cochrane Database Syst Rev 2017;6:CD004637.
3. ACOG Practice Bulletin No. 195: prevention of infection after gynecologic procedures. Obstet Gynecol 2018;131:e172-e189.
4. Sartelli M, Labricciosa FM, Barbadoro P, et al. The Global Alliance for Infections in Surgery : defining a model for antimicrobial stewardship-results from an international cross-sectional survey. World J Emerg Surg 2017;12:34.
5. Wright JD, Hassan K, Ananth CV, et al. Use of guideline-based antibiotic prophylaxis in women undergoing gynecologic surgery. Obstet Gynecol 2013;122:1145-1153.
6. Watson D, Tita A, Dimperio L, et al. Antibiotic prophylaxis for cesarean delivery among Alabama providers. South Med J 2019;112:170-173.
7. Uppendahl L, Chiles C, Shields S, et al. Appropriate use of prophylactic antibiotic agents in gynecologic surgeries at a Midwestern teaching hospital. Surg Infect (Larchmt) 2018;19:397-402.
8. Kremer KM, Foster RT, Drobnis EZ, et al. Non-indicated use of prophylactic antibiotics in gynaecological surgery at an academic tertiary medical centre. J Obstet Gynaecol 2018;38:543-547.
9. Shapiro R, Laignel R, Kowcheck C, et al. Modifying pre-operative antibiotic overuse in gynecologic surgery. Int J Health Care Qual Assur 2018;31:400-405.
10. Morrill MY, Schimpf MO, Abed H, et al. Antibiotic prophylaxis for selected gynecologic surgeries. Int J Gynaecol Obstet 2013;120:10-15.
11. Pereira N, Hutchinson AP, Lekovich JP, et al. Antibiotic prophylaxis for gynecologic procedures prior to and during the utilization of assisted reproductive technologies: a systematic review. J Pathog 2016;2016:4698314.
12. Wu E, Langsjoen J, Preszynski J, et al. Variation in use of prophylactic antibiotics in gynecologic procedures before and after an educational intervention. South Med J 2017;110:782-784.
13. Davey P, Marwick CA, Scott CL, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev 2017;2:CD003543.
14. Buckel WR, Veillette JJ, Vento TJ, et al. Antimicrobial stewardship in community hospitals. Med Clin North Am 2018;102:913-928.
15. Abubakar U, Syed Sulaiman SA, Adesiyun AG. Impact of pharmacist-led antibiotic stewardship interventions on compliance with surgical antibiotic prophylaxis in obstetric and gynecologic surgeries in Nigeria. PLoS One 2019;14:e0213395.
16. Bergeson SC, Gray J, Ehrmantraut LA, et al. Comparing web-based with mail survey administration of the consumer assessment of healthcare providers and systems (CAHPS®) clinician and group survey. Prim Health Care 2013;3:1000132.
17. Cantuaria ML, Blanes-Vidal V. Self-reported data in environmental health studies: mail vs. web-based surveys. BMC Med Res Methodol 2019;19:238.