NHC Key Lab of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, 200237, China.
Department of Obstetrics, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, China.
BMC Med. 2022 Nov 2;20(1):391. doi: 10.1186/s12916-022-02577-w.
Prophylactic antibiotic use during delivery is common in routine obstetric practice to prevent infection globally, especially in low- and middle-income countries. In China, however, little is currently known about the national estimates for prophylactic antibiotic use during delivery. Therefore, we aimed to describe the prevalence of prophylactic antibiotic use and guideline adherence using national data in China.
This cross-sectional study analyzed a national dataset from the China Labor and Delivery Survey in 2015-2016. The primary outcomes were prophylactic antibiotic use and clinician adherence to WHO recommendations for the prevention and treatment of maternal peripartum infections. We estimated the weighted prevalence of the outcomes with Taylor series linearization and investigated the associated factors of the outcomes with logistic regression.
Of the 72,519 deliveries, the prevalence of antibiotic prophylaxis was 52.0%, varying from 92.8% in Shanxi to 17.3% in Hainan. The prevalence of clinician adherence to the WHO guideline was 79.9%, ranging from 93.4% in Shandong to 50.0% in Shanxi. Prophylactic antibiotic use was associated with cesarean delivery (AOR, 55.77; 95%CI, 25.74-120.86), operative vaginal delivery (AOR, 4.00; 95%CI, 1.64-9.78), preterm (AOR, 1.96; 95%CI, 1.60-2.41), premature rupture of membranes (PROM) (AOR, 2.80; 95%CI, 1.87-4.18), and meconium-stained amniotic fluid (AOR, 1.91; 95%CI, 1.30-2.81) in all deliveries and also episiotomy (AOR, 1.48; 95%CI, 1.02-2.16) in vaginal deliveries. Clinician adherence was positively associated with cesarean delivery (AOR, 5.72; 95%CI, 2.74-11.93) while negatively associated with operative vaginal delivery (AOR, 0.26; 95%CI, 0.11-0.61), PROM (AOR, 0.50; 95%CI, 0.35-0.70), and meconium-stained amniotic fluid (AOR, 0.66; 95%CI, 0.48-0.91) in all deliveries. In vaginal deliveries, clinician adherence was negatively associated with episiotomy (AOR, 0.67; 95%CI, 0.46-0.96) and severe perineal trauma (AOR, 0.09; 95%CI, 0.02-0.44). Besides, clinicians in general hospitals prescribed prophylactic antibiotics more likely (AOR, 2.79; 95%CI, 1.50-5.19) and had a lower adherence (AOR, 0.38; 95%CI, 0.20-0.71) than their peers in maternity hospitals.
We observed that about half of all deliveries in China received antibiotics for prophylaxis, and most deliveries were prescribed according to the WHO guideline. Furthermore, the two prevalence rates for prophylactic antibiotic use and clinician adherence varied widely across provinces of China.
在全球范围内，预防性使用抗生素是分娩常规产科实践中的常见做法，尤其是在中低收入国家。然而，目前在中国，关于分娩时预防性使用抗生素的全国估计数据还很少。因此，我们旨在使用全国数据描述中国分娩时预防性使用抗生素的流行情况和指南的遵循情况。
本横断面研究分析了 2015-2016 年中国分娩调查的全国数据集。主要结局是预防性使用抗生素和临床医生对世卫组织预防和治疗孕产妇围产期感染建议的遵循情况。我们使用泰勒级数线性化估计了这些结果的加权流行率，并使用逻辑回归调查了这些结果的相关因素。
在 72519 例分娩中，抗生素预防使用率为 52.0%，从山西的 92.8%到海南的 17.3%不等。临床医生遵循世卫组织指南的比例为 79.9%，从山东的 93.4%到山西的 50.0%不等。预防性使用抗生素与剖宫产（优势比，55.77；95%置信区间，25.74-120.86）、阴道助产（优势比，4.00；95%置信区间，1.64-9.78）、早产（优势比，1.96；95%置信区间，1.60-2.41）、胎膜早破（优势比，2.80；95%置信区间，1.87-4.18）和胎粪污染羊水（优势比，1.91；95%置信区间，1.30-2.81）有关，在所有分娩中还与会阴切开术（优势比，1.48；95%置信区间，1.02-2.16）有关，在阴道分娩中还与阴道助产（优势比，0.26；95%置信区间，0.11-0.61）、胎膜早破（优势比，0.50；95%置信区间，0.35-0.70）和胎粪污染羊水（优势比，0.66；95%置信区间，0.48-0.91）有关。在阴道分娩中，临床医生的遵医嘱情况与会阴切开术（优势比，0.67；95%置信区间，0.46-0.96）和严重会阴创伤（优势比，0.09；95%置信区间，0.02-0.44）呈负相关。此外，与妇幼保健院的同行相比，综合医院的临床医生更有可能（优势比，2.79；95%置信区间，1.50-5.19）开具预防性抗生素处方，且遵医嘱情况更差（优势比，0.38；95%置信区间，0.20-0.71）。
我们观察到，中国约有一半的分娩接受了抗生素预防用药，而且大多数分娩都按照世卫组织的指南进行了用药。此外，预防性使用抗生素和临床医生遵医嘱的两个流行率在中国各省之间差异很大。
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