Antibiotic prophylaxis for caesarean section at a Ugandan hospital: a randomised clinical trial evaluating the effect of administration time on the incidence of postoperative infections.

Lomangisi D Dlamini,Arthur Kwizera,Davidson Ocen,Musa Sekikubo,Agnes Wabule,Janat Tumukunde,Charles Kojjo

doi:10.1186/s12884-015-0514-3

Lomangisi D Dlamini, Arthur Kwizera + Show 5 more

Open Access

https://doi.org/10.1186/s12884-015-0514-3

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Journal: BMC Pregnancy and Childbirth	Publication Date: Apr 12, 2015
Citations: 28	License type: CC BY 4.0

Affiliation: Makerere University

Abstract

BackgroundProphylactic antibiotics are used to prevent postoperative infections after caesarean section. Studies have suggested that the timing of prophylaxis plays an important role. Over the years, the role of the anaesthesiologist in the administration of prophylactic antibiotics has become prominent. Therefore, there is an increasing need for anaesthesia providers to understand the rationale of antibiotic prophylaxis. We therefore sought to compare the effect of antibiotics prophylaxis within 1 hour before skin incision and after skin incision on the incidence of postoperative infections in patients undergoing caesarean section at Mulago Hospital.MethodsWe conducted a single-blind randomised clinical trial conducted at Mulago Hospital evaluating 464 patients undergoing emergency caesarean section. Patients were randomly assigned a group number that allocated them to either arm of the study. They received the same prophylactic antibiotic according to their allotment, that is, either within 1 hour before skin incision or after skin incision as per current standards of practice in Mulago Hospital. They were followed up to detect infection up to 10 days postoperatively. The primary outcome was postoperative infection. The data collected were analysed with STATA version 12 using univariate and bivariate analysis.ResultsThe risk of overall postoperative infection was significantly lower when prophylaxis was given within an hour before incision (RR O.77, 95% CI 0.62–0.97). We also found endometritis to be significantly reduced in the pre-incision group (RR 0.62; 95% CI 0.39–0.99; P value 0.036).ConclusionsGiving prophylactic antibiotics before skin incision reduces risk of postoperative infection, in particular of endometritis.Trial registrationPan African Clinical Trial Registry PACTR201311000610495.Date of trial registration: 12th August 2013.

Highlights

Prophylactic antibiotics are used to prevent postoperative infections after caesarean section
Caesarean section is one of the most common surgical procedures performed in medical practice worldwide, and it is the most common surgical procedure performed in obstetrics and gynaecology practice at Mulago hospital
Administration of prophylactic antibiotics within 1 hour before skin incision significantly reduced the overall incidence of postoperative infections

Summary

Introduction

Prophylactic antibiotics are used to prevent postoperative infections after caesarean section. We sought to compare the effect of antibiotics prophylaxis within 1 hour before skin incision and after skin incision on the incidence of postoperative infections in patients undergoing caesarean section at Mulago Hospital. One of the most important risk factors of postpartum infection in both developed and developing countries is caesarean section [2]. Caesarean section is one of the most common surgical procedures performed in medical practice worldwide, and it is the most common surgical procedure performed in obstetrics and gynaecology practice at Mulago hospital. One of the measures applied to prevent infectious complications following caesarean section is the use of prophylactic antibiotics [7,8]. The purpose of antibiotic prophylaxis in surgical procedures is not to sterilise tissues but to reduce colonisation pressure of microorganisms introduced at the time of the operation to a level that can be overcome by the patient’s immune system [9,10]

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