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Antibiotic Prophylaxis for Cesarean Delivery: A National Survey of Anesthesiologists
Abstract Number: T5D-6
Abstract Type: Original Research
Background: The most common serious complication after cesarean delivery is surgical site infection. Antibiotic prophylaxis reduces postoperative infectious morbidity, and current anesthetic quality metrics include pre-incision antibiotic prophylaxis administration (1). Recently, studies suggest greater reductions in infectious morbidity with the addition of azithromycin for unscheduled cesarean delivery (2). Larger doses of cefazolin are recommended in morbidly obese women (3). The aim of this study was to assess current clinical practice for antibiotic prophylaxis for cesarean delivery by surveying anesthesiologists nationwide.
Methods: We invited a random sample of 10,000 current members of the American Society of Anesthesiologists (ASA) to complete an online survey. The survey included questions similar to a previous survey on this topic in 2012 with a few new added questions (4).
Results: The response rate was 12.2% (n=1223). A majority of respondents had at least 15 years of experience (684, 55.9%), work at a non-teaching or community hospital (729, 59.6%), work at hospitals with >500 cesarean deliveries annually (619, 50.6%) and administer obstetric anesthesia several times a week (690, 56.4%). Routine pre-incision antibiotic prophylaxis was reported by 1162 (95.0%) of the 1223 respondents, a substantial improvement versus the rate of 63.5% reported in the previous study in 2012. For intrapartum cesarean deliveries, 141 (11.5%) administer azithromycin. Of those who use cefazolin for prophylaxis, 509 (42.5%) administer 3g for morbidly obese women, as compared to 654 (54.5%) who use 2g and 36 (3%) who use 1g. Anesthesiologists reported changing their antibiotic practice within the past year (63, 5.2%), past 1-7 years (463, 37.9%), and greater than 7 years ago (301, 24.6%) versus 396 (32.4%) who stated this was how they trained.
Conclusions: Adherence to pre-incision antibiotic prophylaxis for cesarean delivery is very high, a significant improvement within 5 years. A minority of anesthesiologists have started utilizing azithromycin for intrapartum cesarean deliveries. The dose of cefazolin for morbidly obese women varies widely. The results highlight the importance of repeating surveys utilizing the same tool to assess changes in practice, and areas still requiring improvement.
1. Obstet Gynecol. 2011 Jun;117(6):1472-83.
2. N Engl J Med. 2016 Sep 29;375(13):1231-41.
3. Am J Health Syst Pharm. 2013 Feb 1;70(3):195-283.
4. Anesth Analg. 2013 Mar;116(3):644-8.