Antibiotic Misuse Prevalent in Gynecologic Surgery
(HealthDay News) – Most women who undergo antibiotic-appropriate gynecologic procedures receive appropriate antibiotic prophylaxis, while antibiotics are administered to >40% of those undergoing antibiotic-inappropriate procedures, according to a study published online Nov. 6 in Obstetrics & Gynecology.
Jason D. Wright, MD, from Columbia University in New York City, and colleagues examined guideline-based use of prophylactic antibiotics in a cohort of women who underwent gynecologic surgery between 2003 and 2010. Antibiotic use was assessed for antibiotic-appropriate (abdominal, vaginal, or laparoscopically-assisted vaginal hysterectomy; 545,332 women) or antibiotic-inappropriate (oophorectomy, cystectomy, dilation and curettage, myomectomy, and tubal ligation; 491,071 women) procedures.
The researchers found that 87.1% of women who underwent antibiotic-appropriate procedures received appropriate antibiotic prophylaxis, while 2.3% received non-guideline-recommended antibiotics and 10.6% received no antibiotics. There was a significant increase noted in antibiotic use, from 88% in 2003 to 90.7% in 2010 (P<0.001). More than one-quarter of women (26.7%) received antibiotics >24 hours after surgery, after exclusion of patients with infectious complications. Antibiotics were administered to 40.2% of women who underwent procedures for which antibiotics were not recommended. There was a significant increase over time in use of non-guideline-based antibiotics, from 33.4% in 2003 to 43.7% in 2010 (P<0.001). The strongest predictors of guideline-based and non-guideline-based antibiotic use were year of diagnosis, surgeon and hospital procedural volume, and area of residence.
"The widespread misuse of perioperative antibiotics for gynecologic surgery suggests that strategies to better align practice patterns with evidence-based recommendations are urgently needed," the authors write.