Preprocedure Antibiotics Reduce Infection After Cesarean Delivery

Preprocedure Antibiotics Reduce Infection After Cesarean Delivery

Nov 2012

A change in policy to give prophylactic antibiotics before incision instead of after cord clamping significantly reduced the risk of surgical-site infections in women undergoing cesarean delivery at a tertiary care hospital.

More than 31% of infants in the United States are delivered by cesarean section, and the rate of surgical-site infection ranges from 1.46 to 3.82 per 100 cesarean deliveries, depending on patient risk factors. Until recently, usual practice was to wait to administer antibiotics until after umbilical cord clamping to avoid masking neonatal sepsis. Practice guidelines issued in 2011, however, recommend giving antibiotics to all women within an hour before cesarean delivery.

Between 2003 and 2010, Barnes-Jewish Hospital in St. Louis implemented several interventions to reduce the risk of postcesarean infection, including the administration of prophylactic antibiotics before incision instead of after delivery, a ban on artificial nails among surgical staff, and streamlined operating room cleaning and disinfection procedures. Researchers used time series analysis to determine the effects of these interventions (after adjusting for secular trends in patient risk factors) on rates of postcesarean surgical-site infection in the eight-year study period.

Full Article:

American Journal Nursing

Etiological diagnosis reduces the use of antibiotics in infants with bronchiolitis.

Etiological diagnosis reduces the use of antibiotics in infants with bronchiolitis.

Sept 2012

Ferronato AE, Gilio AE, Ferraro AA, Paulis Md, Vieira SE.

Source

University Hospital, Universidade de São Paulo, São Paulo, SP, Brazil.

Abstract

OBJECTIVE:

Acute bronchiolitis is a leading cause of infant hospitalization and is most commonly caused by respiratory syncytial virus. Etiological tests are not required for its diagnosis, but the influence of viral screening on the therapeutic approach for acute bronchiolitis remains unclear.

METHODS:

A historical cohort was performed to assess the impact of viral screening on drug prescriptions. The study included infants up to one year of age who were hospitalized for bronchiolitis. Virus screening was performed using immunofluorescence assays in nasopharyngeal aspirates. The clinical data were obtained from the patients' medical records. Therapeutic changes were considered to be associated with viral screening when made within 24 hours of the release of the results.

RESULTS:

The frequency of prescriptions for beta agonists, corticosteroids and antibiotics was high at the time of admission and was similar among the 230 patients. The diagnosis of pneumonia and otitis was associated with the introduction of antibiotics but did not influence antibiotics maintenance after the results of the virus screening were obtained. Changes in the prescriptions were more frequent for the respiratory syncytial virus patients compared to patients who had negative viral screening results (p =0.004), especially the discontinuation of antibiotics (p<0 .001=".001" associated="associated" class="highlight" identification="identification" nbsp="nbsp" of="of" respiratory="respiratory" span="span" style="border: 0px; font-size: 15.600000381469727px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline;" suspension="suspension" syncytial="syncytial" the="the" virus="virus" was="was" with="with">antibiotics

 (p= 0.003), even after adjusting for confounding variables (p = 0.004); however, it did not influence the suspension of beta-agonists or corticosteroids.

CONCLUSION:

The identification of respiratory syncytial virus in infants with bronchiolitis was independently associated with the discontinuation of antibiotics during hospitalization.

PubMed