Drug Utilization Review Of Surgical Prophylaxis In High Risk Cesarean Section

Objectives

Antibiotic prophylaxis can significantly reduce undesirable outcomes in high risk patients undergoing Cesarean Section.  Our objective was to determine antibiotic prophylaxis patterns, outcomes and associated cost-savings issues in high risk patients undergoing Cesarean Section.

Setting

A Canadian community  hospital.

Design

A retrospective chart review was performed on 275 consecutively selected patients who underwent Cesarean Sections in three hospitals from the Simon Fraser Health Region (SFHR). 171 patients met the criteria.

Results

Rate of antibiotic prophylaxis between three hospitals ranged from 63.3% to 88.2%. Cefazolin or clindamycin was prescribed in 78.5% of cases.  Cefotetan was prescribed in 11.5% of cases. Primary endpoint was composite clinical endpoint (CCE), consisting of febrile morbidity, endometritis and wound infection. Antibiotic prophylaxis reduced CCE from 29.3% to 8.5% (RR 0.29, p<0.005). Secondary endpoints were clinical infection (endometritis, wound infection) and endometritis. Antibiotic prophylaxis reduced clinical infection from 22.0% to 4.6% (RR 0.21, p<0.005) and endometritis from 22.0% to 3.8% (RR 0.17, p<0.005). Length of stay (LOS) was reduced from 4.9 days to 3.5 days (p < 0.05). Universal antibiotic prophylaxis can result in annual savings of $3,387 and 95 inpatient-days.

Conclusions

There is significant variation amongst hospitals in the region. Universal antibiotic prophylaxis with cefazolin or clindamycin for all high risk patients undergoing C-section should decrease infection rates, drug expenditures and length of stay.


Jonathan S.C. Lau, B.Sc.(Pharm), Anthony Taddei, Pharm.D., Paula Kimoto, B.Sc.(Pharm), Carrie Wong, M.D.

Department of Pharmacy, Burnaby Hospital, Simon Fraser Health Region, Burnaby, British Columbia, Canada

Canadian Society of Hospital Pharmacists (British Columbia Branch) Residency Research Presentation Night, Vancouver, British Columbia, Canada. May 8, 2002.

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