Liabsuetrakul Tippawan, Islam Monir
Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
J Obstet Gynaecol Res. 2005 Jun;31(3):202-9. doi: 10.1111/j.1447-0756.2005.00273.x.
To assess the pattern of prophylactic antibiotic use in cesarean sections, identify factors associated with single-dose prescriptions as evidence-based best practice, and evaluate the changes in use of single-dose compared with multiple-dose regimens and the variation of use between doctors after dissemination of evidence.
An analytical descriptive study was conducted. The medical records of 432 women undergoing cesarean section from April to September 2001 after dissemination of evidence in a teaching hospital in Southern Thailand were reviewed. Use of single-dose prophylactic antibiotic was the main outcome measure. Patterns of prophylactic antibiotics, and factors associated with pregnant women and doctors, were analyzed and compared with baseline data among 463 women undergoing cesarean section in 1998. Multivariate logistic regression with random effects was used for analysis.
After the dissemination of evidence, the rate of single-dose prescriptions increased from 14.2 to 22.4% (P < 0.01), single-dose prescriptions decreased for patients who had experienced longer durations of ruptured membranes, and the timing of the administration of antibiotics improved, but multiple-dose and duration of postoperative prescriptions increased. The variation in prescribing antibiotics between doctors was significant (P < 0.001).
Knowledge of evidence alone does not improve practices uniformly. Consequently, other interventions are necessary to improve practices.
评估剖宫产术中预防性抗生素的使用模式，确定与单剂量处方相关的因素作为循证最佳实践，并评估与多剂量方案相比单剂量使用的变化以及在证据传播后医生之间使用情况的差异。
进行一项分析性描述性研究。回顾了2001年4月至9月在泰国南部一家教学医院证据传播后接受剖宫产的432名妇女的病历。使用单剂量预防性抗生素是主要的结局指标。分析预防性抗生素的使用模式以及与孕妇和医生相关的因素，并与1998年463名接受剖宫产妇女的基线数据进行比较。采用具有随机效应的多变量逻辑回归进行分析。
证据传播后，单剂量处方率从14.2%提高到22.4%（P<0.01），胎膜破裂时间较长的患者单剂量处方减少，抗生素给药时机有所改善，但多剂量和术后处方持续时间增加。医生之间抗生素处方的差异显著（P<0.001）。
仅了解证据并不能统一改善实践。因此，需要其他干预措施来改善实践。
