Stewardship opportunities in peripartum infections: a review of quality improvement initiatives and future directions.

Antimicrobial resistance is an urgent public health threat, and despite significant consumption of antimicrobials in pregnancy, there remain opportunities for improvement of their use in the obstetric population. Improvement in antimicrobial utilization can be streamlined by assessing baseline characteristics, utilization of diagnostic testing, awareness of peripartum protocols, and recognition of penicillin allergies. In a single healthcare system including 8 obstetric hospitals, an administrative review identified 199 different regimens used among 8,528 patients based on American College of Obstetrician and Gynecologists (ACOG) guidelines. Other notable factors include 65.6% of patients having no cultures obtained despite being started on empiric antibiotics, duplicative coverage when multiple clinical scenarios overlap, and a high incidence of reported penicillin allergies with obstetric providers lacking comfort to reconcile and de-label allergies. By reviewing these individual aspects, this can highlight opportunities for improvement of antimicrobial use and stewardship in obstetric populations.