title: The effect of antibiotic prophylaxis guidelines on surgical-site infections associated with cesarean delivery.
abstract: OBJECTIVE
  To evaluate the effect of Norwegian antibiotic prophylaxis guidelines on rates of superficial and deep surgical-site infections (SSIs) associated with cesarean delivery (CD).
  
  
  METHODS
  A cross-sectional study was conducted that analyzed the physician-diagnosed SSIs by regimen of antibiotic prophylaxis among women who underwent planned or emergency CD at one of 42 hospitals between January 1, 2008, and December 31, 2010. The antibiotic prophylaxis regimen was verified using a hospital survey, whereas guideline compliance was assessed as part of the mandatory Norwegian Surveillance System for Healthcare-Associated Infections.
  
  
  RESULTS
  Data for 4498 patients were used. Hospitals that practiced antibiotic prophylaxis for all CDs (n=4) provided antibiotics more often in both emergency and planned CDs than did those that used this approach for emergency CDs only (n=33) or had no written guidelines or used prophylaxis on indication only (n=5) (P<0.001). The provision of antibiotic prophylaxis for all cases of CD was associated with markedly lowered rates of superficial SSIs among planned CDs, whereas no differences in rates of deep SSIs were observed between the guidelines in either planned or emergency CDs.
  
  
  CONCLUSIONS
  Hospitals that provided antibiotic prophylaxis to all women undergoing CD reported high compliance and had reduced rates of superficial SSIs among planned CDs.
authors.affiliation: Department of Infectious Disease Epidemiology, National Institute of Public Health, Oslo, Norway; Department of Clinical Medicine, The University of Tromsø, The Arctic University of Norway, Tromsø, Norway. Electronic address: eskjelde@online.no.
authors.forename: Finn Egil
authors.initials: FE
authors.lastname: Skjeldestad
authors.affiliation: Department of Infectious Disease Epidemiology, National Institute of Public Health, Oslo, Norway.
authors.forename: Jørgen V
authors.initials: JV
authors.lastname: Bjørnholt
authors.affiliation: Department of Infectious Disease Epidemiology, National Institute of Public Health, Oslo, Norway; Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
authors.forename: Jon M
authors.initials: JM
authors.lastname: Gran
authors.affiliation: Department of Infectious Disease Epidemiology, National Institute of Public Health, Oslo, Norway.
authors.forename: Hanne-Merete
authors.initials: HM
authors.lastname: Erisken
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D002585:Cesarean Section / Q000379:methods*; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008875:Middle Aged; D009664:Norway; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic prophylaxis; Cesarean delivery; Guidelines; Infection control; Infection prevention; Surgical-site infection