Antibiotic prophylaxis at caesarean section – guidelines and practices - Norway

Background: As a supplement the Norwegian surveillance system of surgical site infections (NOIS) initiated a survey comprising hospitalbased quidelines with focus on regimen and timing of antibiotic prophylaxis (ABP) during caesarean section (CS). National Norwegian guidelines recommend ABP for all acute CS and on indications such as long duration of surgery/severe bleeding in elective CS. A single dose of ampicillin or first generation cephalosporin is recommended without specifying timing or dose. Cochrane recommendations are ABP for all CS at start of surgery. A study from 1997 found large variation in use of ABP in CS at 48 Danish hospitals.

Objective: to explore ABP regimes and timing of administration in CS in Norwegian hospitals relative guidelines. 

Methods: A survey targeting compliance with guidelines, regimen and timing of ABP during CS in hospitals carrying out CS in 2008 was undertaken in 2010.

Results: After two reminders, 27 out 42 hospitals responded, whereas data from the remaining 15 hospitals were collected through telephone interview. Four hospitals (10%) had no written guidelines, five hospitals gave ABP to all CS, whereas the remaining 33 hospitals administered ABP to all acute CS. In the latter group 15 hospitals practiced ABP on indications for elective CS.  Regarding timing 12 hospitals administered ABP at start of surgery, whereas the remaining 26 hospitals gave ABP after clamping. Most hospitals used 1^st  (n=21) or 2^nd (n=12) generation cephalosporins, among which 2 hospitals practiced extended prophylaxis with metronidazol after clamping.  Four hospitals recommended ampicillin whereas one hospital used clindamycin.  During the presentation data for how ABP are practiced in relation to national- and hospitalbased guidelines will be presented.

Conclusions: Large practice variations in handling of ABP during CS are documented. National guidelines and practices are not in accordance with existing Cochrane recommendations. There is a need to revise national guidelines.