Antibiotic use trends for vaginal deliveries

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Recently published research suggests that significant progress has been made in reducing antibiotic use without indication during vaginal delivery hospitalizations. The study, which appeared in Obstetrics & Gynecology, analyzed hospitalizations for more than 5 million deliveries.

Although appropriate antibiotic use may result in significant maternal and neonatal benefits, inappropriate use could result in unnecessary maternal and neonatal risk and could contribute to antibiotic overuse. The purpose of the study was to evaluate antibiotic trends during delivery hospitalizations in the United States.

Methods
The data used were from the Premier Perspective database, an administrative inpatient database that reports on 100% of hospitalizations for 600 individual hospitals and ambulatory surgery centers across the United States. For the analysis, all women between aged 18 to 54 years who underwent a delivery hospitalization from January 2006 through March 2015 were included. The Perspective Database was also queried for antibiotics that are commonly used during delivery hospitalizations, including generics.

The authors identified delivery hospitalizations based on ICD-9-CM billing codes. Evidence-based indications for antibiotic administration during vaginal deliveries included: 1) preterm prelabor rupture of membranes (PPROM); 2) endometritis; 3) chorioamnionitis; 4) group B Streptococcus (GBS) colonization; and 5) other infectious complications (i.e. urinary tract infection [UTI], pneumonia, and sepsis). The authors also evaluated temporal trends in antibiotic administration for all cesarean deliveries and vaginal deliveries with an evidence-based indication for antibiotic administration.

Results
A total of 5,536,756 delivery hospitalizations from 2006 through the first quarter of 2015 were included in the study. This included 2,872,286 vaginal deliveries without indications for antibiotics, 765,096 vaginal deliveries with an evidence-based indication for antibiotic administration, and 1,899,374 cesarean deliveries. The most common indication for antibiotics was cesarean delivery (33.6% of the entire cohort), followed by GBS colonization (15.8%), chorioamnionitis (1.7%), PPROM (1.6%), endometritis (1.2%), UTI (0.6%), and other infections (total < 0.5%). Patients who underwent vaginal delivery with an indication for antibiotics were significantly more likely to be aged 35 or older, single, and black (P <. 01 for all).

The authors found that 30.6% of women with a vaginal delivery and no indication for antibiotic administration received an antibiotic during the study period. However, over the study period, the proportion of women who received antibiotics with a vaginal delivery and without indication decreased 44.4% from 38.1% in 2006 to 21.2% in 2015. The proportion of women receiving antibiotics with a vaginal delivery and an evidence-based indication for antibiotic administration decreased 9.1% from 84.0% to 76.4% and increased for cesarean delivery by 25% from 87.3% to 89.5%. In the adjusted model for receipt of antibiotics during vaginal delivery hospitalizations with an indication for antibiotics, risk was lower in 2015 vs 2006 (adjusted RR 0.92, 95% CI 0.91-0.92).

Conclusions
The authors believe their finding that administration of antibiotics during vaginal delivery hospitalizations without an indication for antibiotic use declined significantly represents a meaningful improvement in obstetric care. However, hospital system-level clinical studies further characterizing antibiotic sue with granular informatics data are needed to better analyze care quality and optimization with regard to use of antibiotics.