Divisions of Maternal-Fetal Medicine and Gynecologic Oncology, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
Obstet Gynecol. 2014 Aug;124(2 Pt 1):338-344. doi: 10.1097/AOG.0000000000000392.
Perioperative antibiotics are recommended during cesarean delivery to reduce the risk of postoperative infections and resulting maternal morbidity. We examined the patterns of use and predictors of receipt of antibiotics in women undergoing cesarean delivery.
We identified a national cohort of women who underwent a cesarean delivery between 2003 and 2010 using a commercial hospitalization database. Women who received antibiotics on the day of cesarean delivery were classified as having received perioperative antibiotics. Multivariable regression models were developed to account for patient, obstetric, physician, and hospital factors on receipt of antibiotics. Between-hospital variation was calculated using generalized linear mixed models.
Among 1,137,804 women who underwent cesarean delivery, 59.5% received perioperative antibiotics. The proportion of patients receiving antibiotics increased over time from 52.5% in 2003 to 63.1% in 2010 (P<.001) and varied significantly by geographic region. Women who did not labor were more likely to receive antibiotics than those who had a cesarean delivery after labor (66% compared with 44%, P<.001). Age, race, and insurance status were not major determinants of the use of perioperative antibiotics.
Among women undergoing cesarean delivery, compliance with the recommendation for universal perioperative antibiotic prophylaxis is poor. Coordinated efforts are needed to enhance use of guideline-based perioperative antibiotic prophylaxis for women undergoing cesarean delivery.
III.
剖宫产术围手术期推荐使用抗生素，以降低术后感染和产妇发病率的风险。我们研究了行剖宫产术的妇女使用抗生素的模式和接受抗生素的预测因素。
我们使用商业住院数据库确定了 2003 年至 2010 年间行剖宫产术的全国性队列妇女。在剖宫产当天接受抗生素治疗的妇女被归类为接受了围手术期抗生素治疗。采用多变量回归模型来解释患者、产科、医生和医院因素对接受抗生素治疗的影响。使用广义线性混合模型计算医院间的变异。
在 1137804 例行剖宫产术的妇女中，59.5%接受了围手术期抗生素治疗。接受抗生素治疗的患者比例随着时间的推移而增加，从 2003 年的 52.5%增加到 2010 年的 63.1%（P<.001），且地区间差异显著。未分娩的妇女比分娩后行剖宫产术的妇女更有可能接受抗生素治疗（66%比 44%，P<.001）。年龄、种族和保险状况不是围手术期使用抗生素的主要决定因素。
在接受剖宫产术的妇女中，普遍围手术期抗生素预防的建议执行情况不佳。需要协调努力，以加强基于指南的围手术期抗生素预防在接受剖宫产术的妇女中的应用。
III 级。
