Impact of antimicrobial stewardship interventions on post-elective caesarean antibiotic prophylaxis and surgical site infections

Background Antimicrobial stewardship programs (ASP) aim to improve appropriate antimicrobial use but few studies have described its impact on unique population such as obstetrics. Post-operative antibiotics are unnecessary especially in those without surgical site infections (SSI) risk factors (e.g., obesity). Objectives To evaluate the impact of ASP interventions on post-elective caesarean (eLSCS) oral antibiotic prophylaxis rates and patient outcomes. Methods This pre-post quasi-experimental study was conducted over 18 months (2 months pre- and 16 months post-intervention) in all women admitted for eLSCS in our institution. Interventions included eLSCS surgical prophylaxis guideline dissemination and post-eLSCS oral antibiotics was actively discouraged in those without SSI risk factors. This was followed by ASP intervention notes (phase 1) for 3 months, contacting the ward team for the next 7 months (phase 2) and subsequently the primary obstetrics attending in Phase 3 (next 6 months). The primary outcome was post-operative oral antibiotics prescription rates, and secondary outcomes included 30-day post-operative SSI rates. Results A total of 1751 women was reviewed. Appropriateness of pre-operative antibiotic prophylaxis was 99%. There were 244 (13.9%) women pre-intervention and 1507 (86.1%) post-intervention. Post-eLSCS antibiotic prescribing rates reduced significantly post-intervention (200, 82% vs 705, 46.8%, p < 0.001). There was no significant difference in SSI rates pre-post intervention (2, 0.8% vs 28, 1.9%, p = 0.420). There was also no significant difference in SSI rates among those who received post-operative oral antibiotics compared to those without (1.9%, 17 of 905 vs 1.5%, 13 of 846, p = 0.582). Conclusions ASP interventions can reduce unnecessary post-eLSCS antibiotic prophylaxis use without adversely impacting patient safety.