Compliance with preoperative antibiotic prophylaxis in cesarean delivery and its impact on surgical site infections: a national retrospective study of Jordan

Background 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. 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, 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. 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). Factors positively associated with receiving PAP included age, undergoing elective cesarean delivery (adjusted odds ratio [aOR]: 2.60; 95% CI: 2.43–2.79; p < 0.001), and longer time between admission and surgery (aOR per hour: 1.02; 95% CI: 1.02–1.02; 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). Conclusion 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.