Prophylactic antibiotic use during labor and delivery in China: a nationwide, multicenter, hospital-based, cross-sectional study

BACKGROUND: Prophylactic antibiotic use during delivery is common in routine obstetric practice to prevent infection globally, especially in low- and middle-income countries. In China, however, little is currently known about the national estimates for prophylactic antibiotic use during delivery. Therefore, we aimed to describe the prevalence of prophylactic antibiotic use and guideline adherence using national data in China. METHODS: This cross-sectional study analyzed a national dataset from the China Labor and Delivery Survey in 2015–2016. The primary outcomes were prophylactic antibiotic use and clinician adherence to WHO recommendations for the prevention and treatment of maternal peripartum infections. We estimated the weighted prevalence of the outcomes with Taylor series linearization and investigated the associated factors of the outcomes with logistic regression. RESULTS: Of the 72,519 deliveries, the prevalence of antibiotic prophylaxis was 52.0%, varying from 92.8% in Shanxi to 17.3% in Hainan. The prevalence of clinician adherence to the WHO guideline was 79.9%, ranging from 93.4% in Shandong to 50.0% in Shanxi. Prophylactic antibiotic use was associated with cesarean delivery (AOR, 55.77; 95%CI, 25.74–120.86), operative vaginal delivery (AOR, 4.00; 95%CI, 1.64–9.78), preterm (AOR, 1.96; 95%CI, 1.60–2.41), premature rupture of membranes (PROM) (AOR, 2.80; 95%CI, 1.87–4.18), and meconium-stained amniotic fluid (AOR, 1.91; 95%CI, 1.30–2.81) in all deliveries and also episiotomy (AOR, 1.48; 95%CI, 1.02–2.16) in vaginal deliveries. Clinician adherence was positively associated with cesarean delivery (AOR, 5.72; 95%CI, 2.74–11.93) while negatively associated with operative vaginal delivery (AOR, 0.26; 95%CI, 0.11–0.61), PROM (AOR, 0.50; 95%CI, 0.35–0.70), and meconium-stained amniotic fluid (AOR, 0.66; 95%CI, 0.48–0.91) in all deliveries. In vaginal deliveries, clinician adherence was negatively associated with episiotomy (AOR, 0.67; 95%CI, 0.46–0.96) and severe perineal trauma (AOR, 0.09; 95%CI, 0.02–0.44). Besides, clinicians in general hospitals prescribed prophylactic antibiotics more likely (AOR, 2.79; 95%CI, 1.50–5.19) and had a lower adherence (AOR, 0.38; 95%CI, 0.20–0.71) than their peers in maternity hospitals. CONCLUSIONS: We observed that about half of all deliveries in China received antibiotics for prophylaxis, and most deliveries were prescribed according to the WHO guideline. Furthermore, the two prevalence rates for prophylactic antibiotic use and clinician adherence varied widely across provinces of China. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12916-022-02577-w.