Antibiotics for 3rd and 4th Degree Vaginal Lacerations, Uterine Tamponade, and Manual Placental Extraction

2019 ◽  
Vol 37 (01) ◽  
pp. 092-103
Author(s):  
Conrad N. Stern-Ascher ◽  
Yongmei Huang ◽  
Cassandra R. Duffy ◽  
Maria Andrikopoulou ◽  
Jason D. Wright ◽  
...  
Keyword(s):  
Vaginal Delivery ◽  
Antibiotic Use ◽  
The United States ◽  
Sensitivity Analyses ◽  
Antibiotic Administration ◽  
Cross Sectional ◽  
Adjusted Risk ◽  
Clinical Scenarios ◽  
Vaginal Deliveries ◽  
Log Linear

Abstract Objective Trends in use of antibiotics during delivery hospitalizations complicated by (1) 3rd/4th degree vaginal lacerations, (2) manual placenta extraction, and (3) uterine tamponade are not well characterized. The objective of this study was to analyze trends in antibiotic use during vaginal delivery hospitalizations complicated by these three clinical scenarios. Study Design An administrative inpatient database was used to perform a serial cross-sectional analysis of antibiotic administration during delivery hospitalizations in the United States from January 2006 to March 2015. The primary outcome was receipt of antibiotics during vaginal delivery hospitalizations complicated by (1) 3rd and 4th degree vaginal lacerations, (2) manual placenta extraction, and (3) uterine tamponade. Patients with other indications for antibiotics were excluded. The Cochran–Armitage test was used to assess trends. Adjusted log linear regression analyses including demographic, hospital, and obstetric factors were performed to analyze factors associated with antibiotic receipt for each of these three clinical scenarios in both primary and sensitivity analyses. Results From 2006 to 2015 the rate of antibiotic administration during delivery hospitalizations decreased from 43.1% in 2006 to 25.5% for 3rd and 4th degree lacerations and from 59.6% to 49.2% for manual extraction (p < 0.01). Administration of antibiotics in the setting of uterine tamponade decreased from 48.6% in 2006 to 27.6% in 2009 before rising to 62.5% in the first quarter of 2015. In adjusted analyses, comparing the first quarter of 2015 to 2006 adjusted risk ratios for antibiotic administration were 0.61 (95% confidence interval [CI] 0.56–0.66) for 3rd and 4th degree vaginal lacerations, 0.76 (95% CI 0.53–1.09) for manual placental extraction, and 0.83 (95% CI 0.76–0.92) for uterine tamponade. Conclusion Antibiotics are not used consistently during vaginal deliveries complicated by 3rd/4th degree lacerations, manual placenta extraction, and uterine tamponade. These findings support that a significant opportunity exists for comparative effectiveness research to assist in characterizing best practices.

scholarly journals Association of β-Lactam Allergy Documentation and Prophylactic Antibiotic Use in Surgery: A National Cross-Sectional Study of Hospitalized Patients

2020 ◽  
Author(s):  
Christie M Bertram ◽  
Michael Postelnick ◽  
Christian M Mancini ◽  
Xiaoqing Fu ◽  
Yuqing Zhang ◽  
...  
Keyword(s):  
United States ◽  
Adverse Events ◽  
Prophylactic Antibiotic ◽  
Antibiotic Use ◽  
The United States ◽  
Cross Sectional Study ◽  
Site Infection ◽  
Sectional Study ◽  
Surgical Prophylaxis ◽  
Cross Sectional

Abstract Alternative antibiotics for surgical prophylaxis are associated with increased adverse events and surgical site infection compared to cefazolin. In a sample of perioperative inpatients from 100 hospitals in the United States, cefazolin was 9-fold less likely to be used in patients with a documented β-lactam allergy whereas clindamycin was 45-fold more likely.

scholarly journals A Continuing Medical Education Campaign to Improve Use of Antibiotics in Primary Care

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Ronald S. Gibbs ◽  
Carolyn Wieber ◽  
Leslie Myers ◽  
Timothy Jenkins
Keyword(s):  
Medical Education ◽  
Continuing Medical Education ◽  
Acute Bronchitis ◽  
Antibiotic Use ◽  
The United States ◽  
Annual Review ◽  
Course Content ◽  
Inappropriate Use ◽  
Hypothetical Patient ◽  
Clinical Scenarios

Because inappropriate use of antibiotics is common, it is an important area for continuing medical education. At an annual review, we conducted a two-year campaign to achieve appropriate use. Our methods included two surveys, directed course content, programmatic evaluation, and a sample practice audit. Ninety percent of learners perceived inappropriate antibiotic use as a “very big” or “big” problem in the United States, but only 44% perceived this about their practice (P<0.001). Top perceived barriers to appropriate antibiotic use were patient expectations, breaking old habits, and fear that patients would go elsewhere. Top strategies to overcome these barriers were patient educational materials, having guidelines accessible, and developing practice policies. In a hypothetical patient with acute bronchitis, 98% would likely prescribe an antibiotic in certain clinical scenarios even though The Centers for Disease Control and Prevention does not recommend empiric antibiotic treatment. The most common scenarios leading to likely antibiotic prescription were symptoms over 15 days (84%), age over 80 years (70%), and fever (48%). Practitioners are under multiple pressures to prescribe antibiotics even in situations where antibiotics are not recommended (such as acute bronchitis). To achieve complex practice changes such as avoiding inappropriate antibiotic use, no one strategy predominated.

scholarly journals Mask Wearing and Control of SARS-CoV-2 Transmission in the United States

2020 ◽  
Author(s):  
Benjamin Rader ◽  
Laura F White ◽  
Michael R Burns ◽  
Jack Chen ◽  
Joe Brilliant ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Grocery Store ◽  
Sensitivity Analyses ◽  
Reproductive Number ◽  
Positive Trend ◽  
Respiratory Pathogens ◽  
Transmission Control ◽  
Cross Sectional ◽  
Social Distancing

Introduction: Cloth face coverings and surgical masks have become commonplace across the United States in response to the SARS-CoV-2 epidemic. While evidence suggests masks help curb the spread of respiratory pathogens, population level, empirical research remains limited. Face masks have quickly become a topic of public debate as government mandates have started requiring their use. Here we investigate the association between self-reported mask wearing, social distancing and community SARS-CoV-2 transmission in the United States, as well as the effect of statewide mandates on mask uptake. Methods: Serial cross-sectional surveys were administered June 3 through July 27, 2020 via a web platform. Surveys queried individuals' likelihood to wear a face mask to the grocery store or with family and friends. Responses (N = 378,207) were aggregated by week and state and combined with measures of the instantaneous reproductive number (Rt), social distancing proxies, respondent demographics and other potential sources of confounding. We fit multivariate logistic regression models to estimate the association between mask wearing and community transmission control (Rt <1) for each state and week. Multiple sensitivity analyses were considered to corroborate findings across mask wearing definitions, Rt estimators and data sources. Additionally, mask wearing in 12 states was evaluated two weeks before and after statewide mandates. Results: We find an increasing trend in mask usage across the U.S., although uptake varies by geography and demographic groups. A multivariate logistic model controlling for social distancing and other variables found a 10% increase in mask wearing was associated with a 3.53 (95% CI: 2.03, 6.43) odds of transmission control (Rt <1). We also find that communities with high mask wearing and social distancing have the highest predicted probability of a controlled epidemic. These positive associations were maintained across sensitivity analyses. Following state mandates, mask wearing did not show significant statistical changes in uptake, however the positive trend of increased mask wearing over time was preserved. Conclusion: Widespread utilization of face masks combined with social distancing increases the odds of SARS-CoV-2 transmission control. Mask wearing rose separately from government mask mandates, suggesting supplemental public health interventions are needed to maximize mask adoption and disrupt the spread of SARS-CoV-2, especially as social distancing measures are relaxed.

scholarly journals Exposure to air pollution and COVID-19 mortality in the United States: A nationwide cross-sectional study

2020 ◽  
Author(s):  
Xiao Wu ◽  
Rachel C Nethery ◽  
M Benjamin Sabath ◽  
Danielle Braun ◽  
Francesca Dominici
Keyword(s):  
United States ◽  
Air Pollution ◽  
Death Rate ◽  
The United States ◽  
Sensitivity Analyses ◽  
List Type ◽  
County Level ◽  
Cross Sectional ◽  
Increased Risk

AbstractObjectivesUnited States government scientists estimate that COVID-19 may kill tens of thousands of Americans. Many of the pre-existing conditions that increase the risk of death in those with COVID-19 are the same diseases that are affected by long-term exposure to air pollution. We investigated whether long-term average exposure to fine particulate matter (PM2.5) is associated with an increased risk of COVID-19 death in the United States.DesignA nationwide, cross-sectional study using county-level data.Data sourcesCOVID-19 death counts were collected for more than 3,000 counties in the United States (representing 98% of the population) up to April 22, 2020 from Johns Hopkins University, Center for Systems Science and Engineering Coronavirus Resource Center.Main outcome measuresWe fit negative binomial mixed models using county-level COVID-19 deaths as the outcome and county-level long-term average of PM2.5 as the exposure. In the main analysis, we adjusted by 20 potential confounding factors including population size, age distribution, population density, time since the beginning of the outbreak, time since state’s issuance of stay-at-home order, hospital beds, number of individuals tested, weather, and socioeconomic and behavioral variables such as obesity and smoking. We included a random intercept by state to account for potential correlation in counties within the same state. We conducted more than 68 additional sensitivity analyses.ResultsWe found that an increase of only 1 μg/m3 in PM2.5 is associated with an 8% increase in the COVID-19 death rate (95% confidence interval [CI]: 2%, 15%). The results were statistically significant and robust to secondary and sensitivity analyses.ConclusionsA small increase in long-term exposure to PM2.5 leads to a large increase in the COVID-19 death rate. Despite the inherent limitations of the ecological study design, our results underscore the importance of continuing to enforce existing air pollution regulations to protect human health both during and after the COVID-19 crisis. The data and code are publicly available so our analyses can be updated routinely.Summary BoxWhat is already known on this topicLong-term exposure to PM2.5 is linked to many of the comorbidities that have been associated with poor prognosis and death in COVID-19 patients, including cardiovascular and lung disease.PM2.5 exposure is associated with increased risk of severe outcomes in patients with certain infectious respiratory diseases, including influenza, pneumonia, and SARS.Air pollution exposure is known to cause inflammation and cellular damage, and evidence suggests that it may suppress early immune response to infection.What this study addsThis is the first nationwide study of the relationship between historical exposure to air pollution exposure and COVID-19 death rate, relying on data from more than 3,000 counties in the United States. The results suggest that long-term exposure to PM2.5 is associated with higher COVID-19 mortality rates, after adjustment for a wide range of socioeconomic, demographic, weather, behavioral, epidemic stage, and healthcare-related confounders.This study relies entirely on publicly available data and fully reproducible, public code to facilitate continued investigation of these relationships by the broader scientific community as the COVID-19 outbreak evolves and more data become available.A small increase in long-term PM2.5 exposure was associated with a substantial increase in the county’s COVID-19 mortality rate up to April 22, 2020.

scholarly journals Obstetric and Neonatal Outcome in Second-Pregnancy Patients with One Prior Cesarean Section at A Costarican Hospital 2006-2007

2011 ◽  
Vol 52 (1) ◽  
Author(s):  
Manrique Leal Mateos ◽  
Loretta Giacomin Carmiol ◽  
Rafael A Moya Sibaja
Keyword(s):  
Cesarean Section ◽  
Vaginal Delivery ◽  
Neonatal Resuscitation ◽  
Obstetric Complications ◽  
Obstetric Outcomes ◽  
Maternal Complications ◽  
Cross Sectional ◽  
Neonatal Complications ◽  
Vaginal Deliveries ◽  
Prior Cesarean Section

Aim: To analyze neonatal and obstetric outcomes in second-pregnancy patients with 1 prior cesarean section.Materials and methods: This study is a cross-sectional observational study. We analyzed 306 medical records of patients treated at the Dr. Rafael A. Calderón Guardia Hospital (HCG), from January 1st 2006 to December 31st of 2007. Maternal variables associated to prenatal control were age and obstetrical indication of the previous cesarean delivery. Variables associated to delivery were gestational age, type of delivery, obstetric complications, and length of hospital stay. The neonatal variables were weight at birth, 5 minute Apgar score, neonatal complications, need for neonatal resuscitation or newborn hospitalization and length of hospital stay.Results: 59, 1% of the patients with 1 prior cesarean section had successful vaginal delivery. The percentage of maternal complications was significantly higher for those who underwent a cesarean section during labor.Uterine rupture occurred in 1,3% of the cases and no maternal or neonatal deaths were found as a consequence of such complication. The percentage of neonatal complications was similar for both groups. The need for neonatal resuscitation was significantly higher in the group that underwent an elective caesarean delivery.Conclusion: Our results show that at the HCG from January 1st 2006 to December 31st of 2007, a vaginal delivery in second-pregnancy patients with 1 prior caesarean delivery appears to be safe. The percentage of successful vaginal deliveries, obstetric complications and uterine rupture were similar to those reported in international literature. 

scholarly journals Assisted Vaginal Delivery - Preference of Vacuum or Forceps among Obstetricians

2021 ◽  
pp. 147-155
Author(s):  
Vijayalakshmi Gnanasekaran ◽  
Shantha Kanamma ◽  
Shanthi Dhinakaran ◽  
Jikki Kalaiselvi
Keyword(s):  
Vaginal Delivery ◽  
Entire Group ◽  
P Value ◽  
Significant Finding ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Assisted Vaginal Delivery ◽  
Choice Of Procedure ◽  
Vaginal Deliveries ◽  
Assisted Delivery

Objective: To determine the instrument preference among obstetricians practicing operative vaginal deliveries and to determine the prevalence and risks of vacuum or forceps Assisted Vaginal Delivery (AVD). Methods: This cross-sectional study was carried out in ACS Medical and Hospital, Chennai. A total of 520 obstetricians were included in the study. An online questionnaire was sent to all obstetricians in Chennai. The choice of procedure for specific circumstances, instrument preference [use of vacuum or forceps] and views on the complications encountered in both vacuum and forceps use at vaginal delivery were explored. For the replies, we computed means and percentages for the entire group and distinct subgroups. Risk assessment of outcome with exposure as suitable p-value was included in the statistical analysis. Results: Response rate for the questionnaire was 97% (504/520). The findings suggest that obstetricians preference was more towards vacuum due to their ease of usage.   Baseline characteristics were similar between the two groups. Failed vacuum due to slipping of the cup was the most common complication faced - 62%, followed by caput succedaneum 25%, both were statistically significant. The most significant finding was that maternal injuries in the vacuum group were only 2% which was way less than those who had forceps delivery (68%) with a p-value of < 0.001. Conclusion: In this research, physician instrument choice is a significant predictor of results that should be taken into account. Use of vacuum for delivery seemed to be the choice of majority of obstetricians [334 (66%)]. Vacuum extractor rather than forceps for assisted delivery appears to reduce maternal morbidity, whereas neonatal injuries were more common in newborns delivered by vacuum. The choice of instrument should be personalized based on the patient's condition and the obstetrician's experience and expertise.

scholarly journals Faktor Risiko Penyebaran Escherichia coli Penghasil ESBL pada Ternak Ayam Komersial

2021 ◽  
Vol 11 (2) ◽  
pp. 146
Author(s):  
Freshinta Jellia Wibisono
Keyword(s):  
Risk Factors ◽  
Escherichia Coli ◽  
Animal Health ◽  
Antibiotic Use ◽  
Cross Sectional Study ◽  
Primary Data ◽  
Antibiotic Administration ◽  
Cross Sectional ◽  
Commercial Chicken ◽  
And Control

Escherichia coli producing ESBL in humans, animals and the environment trigger the emergence of antimicrobial resistance. This study analyzes the potential risk factors in commercial chickens as an infectious factor for the ESBL-producing Escherichia coli as an effort to prevent and control the wider spread of Escherichia coli-producing ESBL events. This study was a descriptive analytic epidemiological study with a cross-sectional study design. Sampling using stratified random sampling by taking as many as 5 samples per commercial chicken farm in Blitar District. Data collection is done by direct interviews with farmers based on a questionnaire and field observations and inspection of livestock, supplemented with supporting documentation. Primary data were obtained through a questionnaire and direct observation of the research object to determine risk factors that could affect the Escherichia coli producing ESBL that were resistant to antibiotics in commercial chicken in Blitar District. Escherichia coli is a commensal bacterium that is naturally present in the chicken digestive tract. The existence of the highest ESBL producing Escherichia coli was 45.56% in the type of partnership farming. Risk factors with the highest association strength on risk factors for partnership type (OR = 11.02, CI 95% = 5.84-20.77), the presence of antibiotic administration programs (OR = 6.76, 95% CI = 2.05-22.22), broiler chicken species ( OR = 5.34, 95% CI = 2.76-10.32), and the purpose of using antibiotics as prevention (OR = 3.55, 95% CI = 1.86-6.74). Efforts to prevent and control the ESBL-producing Escherichia coli in commercial poultry can be done by increasing surveillance of antibiotic use, in this regard it is necessary to supervise animal health personnel in the management of livestock raising for the correct use of antibiotics in commercial chicken farms.

scholarly journals Predictors of Probiotic Use in the United States (P21-023-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Ajita Jadhav ◽  
Kathleen Melanson
Keyword(s):  
Physical Activity ◽  
Large Population ◽  
Antibiotic Use ◽  
The United States ◽  
Healthy Eating Index ◽  
White Population ◽  
Cross Sectional ◽  
Supplement Use ◽  
Unit Increase ◽  
Hispanic White

Abstract Objectives To identify predictors associated with probiotic use in the US using National Health and Nutrition Examination Survey (NHANES) data. Methods The study examined a large cross-sectional US population using NHANES data from 2005–2014. We utilized 24-hour dietary recall (DR) interviews and Dietary Supplement Use 30-Day recall (DSQ) to extract the information of Probiotic Food (PF) or Probiotic Supplements (PS) consumption, respectively, using text search terms. Adults (≥18 years), who participated in DR interviews and DSQ were included, while pregnant women were excluded from the study. Differences in probiotic consumers and non-consumers were analyzed by χ2/Wilcoxon tests. Potential predictors of probiotic use, such as gender, race, Healthy Eating Index (HEI), antibiotic use, Kcal Consumption, Body Mass Index (BMI), age and physical activity were evaluated using multivariate survey-weighted logistic regression. Predictors of PF and PS use were analyzed separately and weighted to reflect national estimates. Results Our study included 15,104,111 (13.79%) PF consumers and 94,421,839 (86.21%) non-consumers. The adjusted analysis suggested that, females were more likely to be PF consumers than males [Weighted Odds Ratio (OR) = 1.75, 95% confidence interval (CI) = 1.56–1.97]. Non-Hispanic white were more likely to consume PF than other races. Each unit increase in HEI was associated with 3% higher odds of PF consumers [1.03, 1.02–1.03] than non-consumers. Similarly, we identified 1108,619 (1.08%) PS users and 101,698,442 (98.92%) non-users. The odds of PS use were 1.75 times higher in females compared to males [1.75, 1.14–2.70]. Mexican American [0.20, 0.09–0.45] and Non Hispanic Black [0.52, 0.32–0.83] were less likely to be PS consumers compared to Non-Hispanic white population. Each unit increase in HEI was associated with 4% higher odds of PS use [1.04, 1.03–1.05] than non-consumers. Antibiotic use (9.37% vs. 4.52%) was significantly associated with PS use [2.30, 1.11–4.74]. Kcal consumption, BMI, age and physical activity were not associated with probiotic consumption. Conclusions This large population based nationally representative study identified females, HEI and Non-Hispanic white population as predictors of probiotic use, while antibiotic use was additional predictor for PS use. Funding Sources None.

Resident Operative Vaginal Delivery Volume after Educational Curriculum Implementation

2020 ◽  
Vol 37 (13) ◽  
pp. 1296-1300
Author(s):  
David A. Becker ◽  
Christina T. Blanchard ◽  
Jeff M. Szychowski ◽  
Sharee L. Rogers ◽  
Cynthia G. Brumfield ◽  
...  
Keyword(s):  
Vaginal Delivery ◽  
Residency Program ◽  
Curriculum Implementation ◽  
The United States ◽  
Assisted Vaginal Delivery ◽  
Regression Curves ◽  
Vaginal Deliveries ◽  
Key Points ◽  
Trends Over Time ◽  
The Impact

Objective The percentage of operative vaginal deliveries (OVDs) in the United States has sharply declined. In May 2016, our institution's obstetrics and gynecology (OB/GYN) residency program implemented a twice-yearly OVD curriculum consisting of didactics and simulation. We sought to evaluate the impact of this curriculum. Study Design We performed a retrospective cohort study of all deliveries at our institution from July 2011 to May 2018. Deliveries were evaluated quarterly for the pre- (July 2011–April 2016) and postcurriculum (July 2016–May 2018) periods. Forceps-assisted vaginal delivery (FAVD), vacuum-assisted vaginal delivery (VAVD), and total OVD percentages, and the ratio of forceps to vacuums were calculated. Pre- and postcurriculum percentages were compared using Wilcoxon's rank-sum test. Cubic regression curves were fit to quarterly percentages to illustrate trends over time. Results The quarterly OVD percentage was unchanged following curriculum implementation (mean 3.2% [Q1–Q3: 2.6–3.5%] pre- vs. 3.1% [2.5–3.8%] post-, p > 0.99). The FAVD percentage was increased (1.2% [0.8–1.5%] vs. 2.0% [1.4–2.6%], p = 0.027) and the VAVD percentage was decreased (2.0% [1.6–2.2%] vs. 1.2% [0.9–1.3%], p < 0.001). This was accompanied by an increase in the ratio of FAVD to VAVD (0.6 [0.4–0.8] vs. 1.7 [1.3–2.2], p < 0.001). FAVD percentage (3.1%) was higher in the last quarter than any other quarter in the 7-year study period, and total OVD percentage (3.9%) was higher in 2018 than any other calendar year. Conclusion The implementation of an OVD curriculum in our OB/GYN residency program resulted in an increase in the percentage of FAVD and the ratio of FAVD to VAVD. Key Points

scholarly journals Antibiotic Use as a Tragedy of the Commons: A Cross-Sectional Survey

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Kieran S. O'Brien ◽  
Seth Blumberg ◽  
Wayne T. A. Enanoria ◽  
Sarah Ackley ◽  
Nicolas Sippl-Swezey ◽  
...  
Keyword(s):  
Infectious Disease ◽  
United States ◽  
Antibiotic Treatment ◽  
Antibiotic Use ◽  
Tragedy Of The Commons ◽  
The United States ◽  
Treatment Programs ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
The Commons

Background. Many believe antibiotic use results in a tragedy of the commons, since overuse may lead to antibiotic resistance and limiting use would benefit society. In contrast, mass antibiotic treatment programs are thought to result in community-wide benefits. A survey was conducted to learn the views of infectious disease experts on the individual- and societal-level consequences of antibiotic use.Methods. The survey instrument was designed to elicit opinions on antibiotic use and resistance. It was sent via SurveyMonkey to infectious disease professionals identified through literature searches. Descriptive statistics were used to analyze the data.Results. A total of 1,530 responses were received for a response rate of 9.9%. Nearly all participants believed antibiotic use could result in a tragedy of the commons, at least in certain circumstances (96.0%). Most participants did not believe mass antibiotic treatment programs could produce societal benefits in an antibiotic-free society (91.4%) or in the United States (94.2%), though more believed such programs would benefit antibiotic-free societies compared to the United States (P<0.001).Conclusions. The experts surveyed believe that antibiotic use can result in a tragedy of the commons and do not believe that mass treatment programs benefit individuals or society.

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