Dr Jill Parkes-smith1, Dr Sumudu Britton2,3, Dr Penny Wolski1,3
1Department of Obstetric Medicine, Royal Brisbane and Womens Hospital, Brisbane, Australia, 2Department of Infectious Diseases, Royal Brisbane and Womens Hospital, Brisbane, Austalia, 3Faculty of Medicine, University of Queensland, Brisbane, Australia
Biography:
Jill Parkes-Smith, is an Obstetric Medicine and Infectious Diseases Physician based in Brisbane working at the Mater Mothers hospital and Ipswich General Hospital. Her clinical interests include optimising the management of infections in pregnancy and improving antibiotic prescribing.
Abstract:
To describe and audit how appropriately antimicrobials were prescribed on the obstetric ward of the Royal Brisbane and Women’s Hospital and to compare these practices with available data from 2019 and 2015 for the purpose of identifying suitable areas for intervention.
This was a retrospective audit of medical records for patients prescribed antimicrobial therapy over a 4 period in 2021 at a 1000 bed tertiary hospital in Brisbane. This data set was compared with previously collated data sets from 2015 and 2019.
During the 2021 study period, 207 antibiotic prescriptions were made for 100 patients. Maternal fever in the peripartum period (20.3%) and prolonged rupture of membranes (20.3%) were the most common indications documented for antibiotics in 2021. This compared with maternal fever as the indication documented for 16.9% and 24.4% of prescriptions respectively in 2019 and 2015. Benzylpenicillin was the most prescribed antibiotic in 2021 reflecting 29.5% of prescriptions. The indication for the antibiotic was documented in the medical record for 60.8% of prescriptions in 2021 and 74% in 2019. In terms of guideline adherence, 77.6% of prescriptions were in keeping with recommended antibiotic and dosage in 2021 where guidelines were available, compared with 64.3% in 2015. There is no guideline available for the indication of maternal fever in labour. The planned duration was recorded in 57.6% of patients.
Maternal fever was one of the most common indications for antibiotics in all data sets and yet no guideline is available for this indication. To improve antimicrobial prescribing for this common obstetric indication, a prospective study evaluating clinical presentation, antibiotic use, resulting microbiological cultures and maternal and neonatal outcomes needs to be undertaken.
Guideline adherence has improved over time; however, documentation of the indication and planned duration continues to be problematic and could be targeted to improve antimicrobial stewardship.
Keywords
Antimicrobial stewardship, Maternal fever, Pregnancy
References
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Jensen CS, Beck Nielsen S, and Fynbo F, Risking antimicrobial resistance : a collection of one-health studies of antibiotics and its social and health consequences. Cham (Switzerland): Palgrave Macmillan; 2019
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