Abstract
BackgroundCaesarean delivery (CD) increases the risk of postpartum infection by 5 to 20 fold. Prevention of surgical site infection (SSI) is the goal of antibiotic prophylaxis. This study was carried out to assess the optimum timing for prophylactic antibiotic administration and to assess the amount of the antibiotic crossing the placental barrier.MethodsEligible mothers were recruited, after informed consent, once the decision for CD was made. Each mother received two injections, one prior to skin incision and one after cord clamping, (one being the study drug Cefazolin, and the other, a placebo) based on the randomization code. Demographic, maternal and neonatal monitoring data until discharge from hospital, and at the 6 weeks postpartum visit were collected. Levels of the prophylactic antibiotic were measured from the cord blood in every 8th neonate. The objective of the study was to compare the effects of the prophylactic antibiotic, intravenous Cefazolin 1 g, administered at Caesarean delivery (CD) at two different timings (before skin incision and after cord clamping) on both the mother and newborn. The secondary outcomes that were followed up were the number of maternal and neonatal readmissions. An appropriate test for significance, Fisher’s exact test was used to find the association between risk variables and outcome.ResultsThe total numbers of mothers enrolled were 1106, of whom 553 mothers received antibiotic prior to skin incision (pre-incision) and 543 mothers received antibiotic after cord clamping (post-incision). The pre-incision group had significantly less febrile illness (RR = 0.48, 95% CI: 0.29 - 0.80) and SSI (RR = 0.14, 95% CI: 0.04 - 0.53) when compared with the post- incision group. The post-incision group significantly had >7 days hospital stay when compared to the 4-7 days stay of the pre-incision group (p = 0.005).There were no differences in any of the neonatal outcomes. The quantity of the antibiotic in the cord blood was only 2-3%.ConclusionsPre incision prophylactic antibiotic protected the mother from SSI and febrile illness and decreased the hospital stay significantly.Trial registrationThe Clinical Trials Registry India (CTRI) was [CTRI/2016/03/006710 dated, 04/03/2016].
Highlights
Caesarean delivery (CD) increases the risk of postpartum infection by 5 to 20 fold
Pre incision prophylactic antibiotic protected the mother from surgical site infection (SSI) and febrile illness and decreased the hospital stay significantly
Administration of IV antibiotics prior to skin incision definitely showed a decrease of 9% in the rate of maternal infections with no increase in the rate of neonatal sepsis, duration of hospital stay for the infant or any complications secondary to the administration of antibiotic to the mother [7].The objectives of the study were: 1. To compare the effects of the prophylactic antibiotic, intravenous Cefazolin1gm, administered at Caesarean delivery (CD) at two different timings(30 min to 1 h) before skin incision and immediately after cord clamping) on both the mother and newborn
Summary
Caesarean delivery (CD) increases the risk of postpartum infection by 5 to 20 fold. Prevention of surgical site infection (SSI) is the goal of antibiotic prophylaxis. Caesarean delivery (CD) is considered an important risk factor for postpartum infection. Prevention of surgical site infection (SSI) by decreasing the burden of microorganisms at the surgical site during the operative procedure is the goal of antibiotic prophylaxis [1]. The efficacy of antibiotic prophylaxis for reducing SSI is well known [2]. Prophylactic antibiotics are expected to work in conjunction with the antiseptic measures taken before and during surgery [3, 4]. Prophylactic antibiotics act mainly by destroying the bacteria and slowing production of bacterial proteases, preventing the attachment of bacteria to the mucosal surfaces. The greatest therapeutic effect occurs when antibiotics are administered just before or coincident when maximal bacterial contamination and tissue trauma occurs
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