Inappropriate use of antibiotic prophylaxis to prevent infective endocarditis in obstetric patients.
OBJECTIVE
To evaluate infective endocarditis prophylaxis practices during the intrapartum period and to assess obstetric providers' adherence to the American Heart Association and American College of Obstetrics and Gynecology guidelines for infective endocarditis prophylaxis.


METHODS
We performed a chart review of pharmacy, electronic nursing, and physician records to report this case series of obstetric patients who received infective endocarditis prophylaxis during the intrapartum period at a single tertiary referral care center during a 1-year study period from August 1, 2004, to July 31, 2005.


RESULTS
Fifty patients received antibiotics for infective endocarditis prophylaxis. Three of the 50 patients who received infective endocarditis prophylaxis had high-risk cardiac lesions and three other patients had moderate-risk cardiac lesions and evidence for intrapartum infection. Thus, only six patients (12.0%, 95% confidence interval 4.5%-24.3%) met the American Heart Association and American College of Obstetricians and Gynecologists criteria for an appropriate indication for infective endocarditis prophylaxis. Of these six patients who had an appropriate indication for infective endocarditis prophylaxis, only three (50.0%, 95% confidence interval 11.8%-88.2%) received appropriate antibiotic regimens.


CONCLUSIONS
Antibiotics are frequently given to obstetric patients during pregnancy. Although many obstetric patients receive antibiotics for recommended indications, some patients, as our study shows, do not. A concerted effort by all practitioners and institutions to reduce the amount of inappropriate antibiotics given to obstetric patients will have positive public health effects in addition to benefiting individual mothers and neonates.
Pocock
Sean B
SB
Department of Obstetrics and Gynecology and Epidemiology, Columbia University, New York, New York 10032, USA.
Chen
Katherine T
KT
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D004363:Drug Utilization; D004697:Endocarditis, Bacterial / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008485:Medical Audit; D008499:Medical Records; D009518:New York / Q000453:epidemiology; D007744:Obstetric Labor Complications / Q000517:prevention & control*; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents