title: Patterns of use and predictors of receipt of antibiotics in women undergoing cesarean delivery.
abstract: OBJECTIVE
  Perioperative antibiotics are recommended during cesarean delivery to reduce the risk of postoperative infections and resulting maternal morbidity. We examined the patterns of use and predictors of receipt of antibiotics in women undergoing cesarean delivery.
  
  
  METHODS
  We identified a national cohort of women who underwent a cesarean delivery between 2003 and 2010 using a commercial hospitalization database. Women who received antibiotics on the day of cesarean delivery were classified as having received perioperative antibiotics. Multivariable regression models were developed to account for patient, obstetric, physician, and hospital factors on receipt of antibiotics. Between-hospital variation was calculated using generalized linear mixed models.
  
  
  RESULTS
  Among 1,137,804 women who underwent cesarean delivery, 59.5% received perioperative antibiotics. The proportion of patients receiving antibiotics increased over time from 52.5% in 2003 to 63.1% in 2010 (P<.001) and varied significantly by geographic region. Women who did not labor were more likely to receive antibiotics than those who had a cesarean delivery after labor (66% compared with 44%, P<.001). Age, race, and insurance status were not major determinants of the use of perioperative antibiotics.
  
  
  CONCLUSIONS
  Among women undergoing cesarean delivery, compliance with the recommendation for universal perioperative antibiotic prophylaxis is poor. Coordinated efforts are needed to enhance use of guideline-based perioperative antibiotic prophylaxis for women undergoing cesarean delivery.
  
  
  METHODS
  III.
authors.affiliation: Divisions of Maternal-Fetal Medicine and Gynecologic Oncology, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
authors.forename: Sara G
authors.initials: SG
authors.lastname: Brubaker
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Friedman
authors.forename: Kirsten Lawrence
authors.initials: KL
authors.lastname: Cleary
authors.forename: Eri
authors.initials: E
authors.lastname: Prendergast
authors.forename: Mary E
authors.initials: ME
authors.lastname: D'Alton
authors.forename: Cande V
authors.initials: CV
authors.lastname: Ananth
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wright
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000592:standards / Q000706:statistics & numerical data* / Q000639:trends; D002585:Cesarean Section; D005260:Female; D019983:Guideline Adherence; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006801:Humans; D007743:Labor, Obstetric; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011247:Pregnancy; D014481:United States; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents