The pattern of antibiotic prophylaxis for cesarean section in Songklanagarind Hospital

The pattern of antibiotic prophylaxis for cesarean section in Songklanagarind Hospital

Thippawan Liabsuetrakul, D. of Obstetrics and Gynaecology, F. of Medicine, PSU.
Pisake Lumbiganon, D. of Obstetrics and Gynaecology, F. of Medicine, Khon Kaen U., Khon Kaen
Virasakdi Chongsuvivatwong, Assoc. Prof., Epidemiology Unit, F. of Medicine, PSU.

Grant : Royal Golden Jubilee Ph.D. Program
Presented : The 15th Annual Scientific Meeting of the Royal Thai College of Obstetricians and Gynaecologists, 17-20 October 2000, Dusit Iceland Resort, Chiang Rai, Thailand
Key words : antibiotic prophylaxis, cesarean section, Songklanagarind Hospital, pattern of antibiotic prophylaxis

Objectives : To assess the pattern of antibiotic prophylaxis for cesarean section, determine the incidence rate of puerperal and infectious morbidity, identify factors associated with prescribing intraoperative antibiotic and test the heterogeneity in giving intraoperative antibiotics among the doctors.

Methods : Medical records of women underwent cesarean section in Songklanagarind Hospital from January 1998 to February 1999 were reviewed. Factors associated with intraoperative prescription and the heterogeneity among doctors were test by repeated measures.

Results : Nineteen percent of women did not receive any antibiotics and twenty percent received only postoperative antibiotics. Nine percent received single-dose intraoperative antibiotics and fifty-two percent received both intraoperative and postoperative antibiotics. The most common antibiotics was ampicillin (99.2%). The puerperal and infectious morbidity before discharge were found in 5.5% and 2.3%, respectively. Three factors that associated with prescribing intraoperative antibiotic use were the duration of ruptured membranes, the number of vaginal examinations and doctor's age. Adjusted odds ratio of ruptured membranes 7-12 hours was 4.1. The adjusted odds ratio of number of vaginal examinations 6 or more was 3.2. The adjusted odds ratio of doctors who aged 30-39 years was 3.0. In contrast, doctors who aged 40 years or more had significant low proportion of giving antibiotic than their younger peers (adjusted odds ratio 0.4). There was no evidence to show the heterogeneity in application of intraoperative antibiotics among doctors.

Conclusion : There were three main regiments of antibiotic prophylaxis, postoperative only, intraoperative only and both intraoperative and postoperative antibiotic. The prevalence of single-dose antibiotic prophylaxis was low.

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