Peri-operative antibiotic prophylaxis in obstetrics: a 6-year evaluation of guideline adherence and stewardship impact in a Ukrainian maternity hospital
Year: 2026
Type: article
Study design: Observational Study
Abstract: Surgical site infections are a major concern in obstetric surgery. In Ukraine, evolving national guidelines and institutional antimicrobial stewardship (AMS) initiatives have sought to optimize perioperative antibiotic prophylaxis (PAP), but their impact on clinical outcomes requires rigorous evaluation. We conducted a retrospective cohort study (2018-2023) of 474 obstetric surgeries to evaluate changes in PAP adherence and its association with length of stay. Adherence was assessed using a 3-point compliance score (timing, choice, duration). The association between compliance and time-to-discharge was analyzed using a multivariable Cox proportional hazards model. A marked improvement in practice was observed; full compliance increased from 11% to 71%, while mean length of stay decreased from 9.9 to 4.7 days. Component analysis showed that structural interventions eliminated duration errors, while errors in antibiotic choice persisted. In the multivariable model, the "year of surgery" was the strongest predictor of earlier discharge (p<0.001), acting as a proxy for holistic systemic improvements. While the compliance score was not an independent predictor in the overall cohort, binary compliance showed a trend towards significance (p=0.098), remaining statistically subordinate to secular trends. A significant association was found only in the highly standardized laparoscopy subgroup, suggesting the impact of protocol adherence is most visible in predictable clinical environments. Multifaceted AMS programs can successfully optimize PAP adherence and improve outcomes. While the overall reduction in length of stay is driven by broad improvements over time, specific guideline adherence remains a crucial quality indicator, particularly for standardized procedures.
Source: Infection Prevention in Practice
Institution: Bogomolets National Medical University
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,500
OpenAlex ID: W7128474733