Inappropriate Use of Antibiotic Prophylaxis to Prevent Infective Endocarditis in Obstetric Patients

Pocock, Sean B. MD, MPH1; Chen, Katherine T. MD, MPH1

Obstetrics & Gynecology:
doi: 10.1097/01.AOG.0000226847.30424.09
Original Research
Abstract

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.

CONCLUSION: 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.

LEVEL OF EVIDENCE: II-3

In Brief

The majority of antibiotics administered to obstetric patients for infective endocarditis prophylaxis are inappropriate according to national guidelines.

Author Information

From the 1Department of Obstetrics and Gynecology and Epidemiology, Columbia University, New York, New York.

Funded by a Women’s Reproductive Health Research Career Development Center Grant From the National Institutes of Child Health and Human Development SK12 HD01275 to Dr. K. Chen.

The authors thank Frances Jordan for data from the pharmacy at Columbia University Medical Center.

Corresponding author: Katherine T. Chen, Department of Obstetrics and Gynecology and Epidemiology, Columbia University, 722 West 168th Street, New York, New York, 10032; e-mail: ktc10@columbia.edu.

© 2006 The American College of Obstetricians and Gynecologists