title: Unwarranted variability in antibiotic prophylaxis for cesarean section delivery: a national survey of anesthesiologists.
abstract: BACKGROUND
  Current guidelines from the American College of Obstetricians and Gynecologists recommend antibiotic prophylaxis for cesarean delivery immediately before incision. The purpose of this study was to measure and describe correlates of adherence to these guidelines in a sample of United States anesthesiologists.
  
  
  METHODS
  We invited a random sample of the membership of the American Society of Anesthesiologists (n = 10,000) to complete an online survey.
  
  
  RESULTS
  Of 1052 respondents (10.5%) with complete information for analysis, 63.5% (95% confidence interval 60.6%, 66.3%, n = 668) reported preincision prophylaxis as the standard of care for scheduled cesarean delivery. Twenty-eight percent (n = 299) agreed that the anesthesiologist should take primary responsibility for prophylaxis timing. In a multivariable model, significant variability in preincision prophylaxis was noted for hospital type (community versus teaching, 62% vs 70%, P = 0.004), region (West versus Southeast, 70% vs 59%, P = 0.01; West versus Southwest, 70% vs 58%, P = 0.02), and respondents' belief in appropriate preincision timing (those endorsing routine preincision administration [80%], routine after cord clamp administration [17%], at the discretion of the obstetrician [47%], and the belief that more information was needed [43%]) (P < 0.001 all comparisons). Respondents' belief about appropriate preincision timing was the strongest discriminator in the model (change in area under the receiver operating characteristic curve = 0.13 vs ≤0.02 for all others).
  
  
  CONCLUSIONS
  Adherence with current prophylactic antibiotic administration guidelines for cesarean delivery is not uniform. Education initiatives, regulatory maneuvers, and process improvement should be targeted at sites where anesthesiologists do not comply with current guidelines.
authors: Department of Anesthesiology, Baystate Medical Center, 759 Chestnut St., Springfield, MA 01199, USA.
authors: Karthik
authors: K
authors: Raghunathan
authors: Neil Roy
authors: NR
authors: Connelly
authors: Jennifer
authors: J
authors: Friderici
authors: Deborah
authors: D
authors: Naglieri-Prescod
authors: Ryan
authors: R
authors: Joyce
authors: Praveen
authors: P
authors: Prasanna
authors: Nandakumar
authors: N
authors: Ponnusamy
mesh_terms: D000776:Anesthesiology / Q000379:methods / Q000592:standards*; D019072:Antibiotic Prophylaxis / Q000379:methods / Q000592:standards*; D001291:Attitude of Health Personnel; D002585:Cesarean Section / Q000379:methods / Q000592:standards*; D003625:Data Collection / Q000379:methods; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D010820:Physicians / Q000592:standards*; D011247:Pregnancy; D014481:United States