Use of intravenous antibiotics for the management of suspected chorioamnionitis: insights from women's wellness and research center.

Abstract

Background: Chorioamnionitis significantly impacts both maternal and neonatal outcomes. Due to the critical need for rapid management, coordinated interprofessional collaboration is essential to ensure prompt administration of intravenous (IV) antibiotic therapy. Hospital pharmacists hold a strategic capacity to enhance clinical outcomes and reinforce safe medication practices. Aim: To describe IV antibiotics prescribing patterns and assess their clinical appropriateness in the treatment of suspected chorioamnionitis at Women Wellness and Research Center (WWRC), evaluate antibiotic-focused pharmacy interventions, and propose evidence-driven strategies to address identified challenges. Method:: A retrospective chart review of IV antibiotics used for females admitted for labor between 01/07/2024 and 31/12/2024 was conducted. Pharmacists' intervention notes related to prescribed antibiotics were collected and analyzed. Descriptive reporting of findings will be provided. Results: A total of 464 pregnant patients were included. Majority were Arab-speaking (55.2%) and 63.1% were primigravida (n = 293). Modes of delivery included cesarean section (34.9%), normal delivery (31.5%), and assisted normal delivery (22.8% vacuum-assisted, 9.7% forceps-assisted). Only 376 (81.4%) of the reported 460 cases met the diagnostic criteria for suspected chorioamnionitis. All patients included received gentamicin, 97.8% received ampicillin (mean duration 2.8 ± 0.7 days), 15.5% received clindamycin (0.5 ± 0.8 days), 20.5% received metronidazole (2.5 ± 1.7 days), and 3.4% received ceftriaxone (2.4 ± 1.2 days). Usage of more than 2 antibiotics was reported in 135 patients (29%). The most reported intervention performed by IV staff and clinical pharmacists was "dosing/ administration" (68.2% and 31.1%, retrospectively). Gentamicin dosing was corrected in 306 prescriptions (65.9%) out of the 464. Gentamicin dosing algorithm and suspected chorioamnionitis diagnosis checklist have been proposed in this work. Conclusion: Observed deviations from recommended guideline-concordant antibiotic use reveal opportunities for system-level optimization initiatives. The findings underscore pharmacists' crucial contributions in intercepting medication-related inaccuracies and advancing sustainable error-reduction strategies to enhance obstetric antimicrobial stewardship and improve patient safety.