Antibiotic usage within cesarean section procedures in resourced-limited Kenya: A study of 23 facilities

Introduction: In Kenyan cesarean sections (CS), antibiotics play a crucial role in preventing surgical site infections. In Kenya, where maternal health care is a pivotal public health concern, understanding the efficacy and appropriateness of antibiotic prophylaxis in CS is crucial. This study seeks to address this gap by understanding antibiotic prophylaxis practices and the classes of antibiotics utilized for prophylaxis during CS in Kenya. Methods: We conducted a cross-sectional survey on infection prevention and control (IPC) practices by adapting the World Health Organization (WHO) IPC assessment framework. One component of this survey included questions on antibiotic prophylaxis for CS. Purposive sampling was used to identify 23 hospitals across seven districts in Kenya that provided CS. Results: All 23 facilities used a form of systemic antibiotic prophylaxis. Preoperative systemic antibiotic prophylaxis was used by 78.2%, and postoperative prophylaxis was universal. The mean duration of postoperative antibiotic prophylaxis was 3.87 days. Ceftriaxone (91.3%), metronidazole (82.6%), and gentamicin (26.1%) were the most common systemic antibiotics. In addition, 91.3% administered oral antibiotics postoperatively, with a mean duration of 5.6 days. Predominant oral antibiotics included metronidazole (82.6%), amoxicillin–clavulanate (60.9%), and ceftriaxone (13.0%). Conclusion: The antibiotic practices utilized within the Kenya setting do not follow either the American College of Obstetricians and Gynecologists (ACOG) or WHO recommendations. Both organizations recommend pre-CS administration of a first-generation cephalosporin 60 min before incision. This class of antibiotics is not used at any of the study sites. In addition, all of the study sites provide postantibiotic prophylaxis, which is not recommended by either ACOG or WHO for prophylaxis.