Compliance with preoperative antibiotic prophylaxis in cesarean delivery and its impact on surgical site infections: A national retrospective study of Jordan.
Only 19.4% of women undergoing cesarean delivery in Jordan received the recommended preoperative antibiotics, but compliance was linked to significantly lower odds of readmission due to surgical site infections.
Where it sits
this study against the rest of the ipamorelin corpusSummary and findings
This study assessed compliance with preoperative antibiotic prophylaxis (PAP) in women undergoing cesarean delivery in Jordan and its impact on surgical site infections (SSIs). Only 19.4% of patients received PAP as recommended, and those who did had 41% lower odds of readmission due to SSIs. The study analyzed data from 60,212 women over a period from 2015 to 2022.
Abstract
<h4>Background</h4>Surgical site infections (SSIs) are significant complications following cesarean delivery, and preoperative antibiotic prophylaxis (PAP) is crucial for prevention. Limited data exist on PAP compliance in low- to middle-income countries such as Jordan. This study aimed to assess the compliance with PAP guidelines in women undergoing cesarean delivery in Jordan and evaluate its impact on the incidence of SSIs.<h4>Methods</h4>A retrospective cross-sectional study was conducted using electronic health records from 60,212 women who underwent cesarean delivery between 2015 and 2022 in 20 Ministry of Health hospitals in Jordan. PAP compliance was defined as the administration of cefazolin (1-2 g) within one hour before surgery for patients without penicillin allergy, or appropriate alternatives for those with an allergy, following USAID and MOH protocols. Multilevel logistic regression models with hospital code as a random effect were used to identify factors associated with PAP compliance and SSIs.<h4>Results</h4>Only 19.4% of patients received PAP as recommended. The monthly rate of women who received antibiotics increased slightly over time by an average of almost 1.0% per month (95% CI: 0.07-0.09; <i>p</i> < 0.001). Factors positively associated with receiving PAP included age, undergoing elective cesarean delivery (adjusted odds ratio [aOR]: 2.60; 95% CI: 2.43-2.79; <i>p</i> < 0.001), and longer time between admission and surgery (aOR per hour: 1.02; 95% CI: 1.02-1.02; <i>p</i> < 0.001). Patients who received PAP had 41% lower odds of readmission due to SSIs (aOR: 0.59; 95% CI: 0.39-0.89; <i>p</i> = 0.012). The monthly rate of SSIs decreased by approximately 1.6% over the study period (incidence rate ratio: 0.984; 95% CI: 0.979-0.989; <i>p</i> < 0.001).<h4>Conclusion</h4>PAP compliance in women undergoing cesarean delivery in Jordan is suboptimal, with less than one-fifth receiving prophylaxis per guidelines. Compliance with PAP is significantly associated with reduced SSIs. Interventions to improve PAP compliance, such as enhancing guideline awareness, implementing antibiotic stewardship programs, and improving preoperative planning, are urgently needed to enhance patient outcomes and reduce postoperative complications.
Background
This paper addresses the compliance with preoperative antibiotic prophylaxis (PAP) in cesarean deliveries and its association with surgical site infections (SSIs). Prior research indicates that SSIs are significant complications following cesarean deliveries, and effective PAP can reduce these risks. Understanding compliance rates in low- to middle-income countries like Jordan is critical for improving surgical outcomes and patient safety.
Methods
A retrospective cross-sectional study was conducted using electronic health records from 60,212 women who underwent cesarean delivery between 2015 and 2022 in 20 Ministry of Health hospitals in Jordan. PAP compliance was defined as the administration of cefazolin (1-2 g) within one hour before surgery for patients without penicillin allergy, or appropriate alternatives for those with an allergy. Multilevel logistic regression models with hospital code as a random effect were used to identify factors associated with PAP compliance and SSIs.
Results
Only 19.4% of patients received PAP as recommended. The monthly rate of women who received antibiotics increased slightly over time by an average of almost 1.0% per month (95% CI: 0.07-0.09; p<0.001). Patients who received PAP had 41% lower odds of readmission due to SSIs (aOR: 0.59; 95% CI: 0.39-0.89; p=0.012). The monthly rate of SSIs decreased by approximately 1.6% over the study period (incidence rate ratio: 0.984; 95% CI: 0.979-0.989; p<0.001).
Interpretation
The findings indicate a significant association between PAP compliance and reduced SSIs, consistent with existing literature that supports the use of prophylactic antibiotics in surgical settings. However, the effect size regarding readmission reduction may not be clinically meaningful given the low compliance rate. Limitations include the retrospective nature of the study, potential inaccuracies in health records, and the need for further interventions to improve compliance.
Key findings
- 19.4% of patients received PAP as recommended.
- Monthly rate of women receiving antibiotics increased by an average of almost 1.0% per month (95% CI: 0.07-0.09; p<0.001).
- Patients who received PAP had 41% lower odds of readmission due to SSIs (aOR: 0.59; 95% CI: 0.39-0.89; p=0.012).
- Monthly rate of SSIs decreased by approximately 1.6% over the study period (incidence rate ratio: 0.984; 95% CI: 0.979-0.989; p<0.001).
Limitations
- Retrospective study design.
- Relies on electronic health records, which may have inaccuracies.
- Low compliance rate indicates potential gaps in practice.
- Single-country study may limit generalizability.