Abstract
BackgroundThe World Health Organization (WHO) recommends administration of surgical antimicrobial prophylaxis (SAP) in cesarean section prior to incision to prevent surgical site infections (SSI). This study aimed to determine whether SAP administration following cord clamping confers an increased SSI risk to the mother.MethodsStudy design: Cohort. Setting: 75 participating Swiss hospitals, from 2009 to 2018. Participants: A total of 55,901 patients were analyzed. Main outcome measures: We assessed the association between SAP administration relative to incision and clamping and the SSI rate, using generalized linear multilevel models, adjusted for patient characteristics, procedural variables, and health-care system factors.ResultsSAP was administered before incision in 26′405 patients (47.2%) and after clamping in 29,496 patients (52.8%). Overall 846 SSIs were documented, of which 379 (1.6% [95% CI, 1.4–1.8%]) occurred before incision and 449 (1.7% [1.5–1.9%]) after clamping (p = 0.759). The adjusted odds ratio for SAP administration after clamping was not significantly associated with an increased SSI rate (1.14, 95% CI 0.96–1.36; p = 0.144) when compared to before incision. Supplementary and subgroup analyses supported these main results.ConclusionsThis study did not confirm an increased SSI risk for the mother in cesarean section if SAP is given after umbilical cord clamping compared to before incision.
Highlights
Surgical antimicrobial prophylaxis (SAP) for cesarean section provides a 60–70% reduction in postpartum endometritis and a 30–65% reduction in wound infections in women who undergo either elective or emergent cesarean delivery [1, 2]
Manuscript at a glance Why was this study conducted? This study is by far the largest study to assess the association between timing of surgical antimicrobial prophylaxis relative to cord
What are the key findings? We were able to demonstrate that the surgical site infection rate is not higher if the prophylaxis is administered after cord clamping
Summary
Surgical antimicrobial prophylaxis (SAP) for cesarean section provides a 60–70% reduction in postpartum endometritis and a 30–65% reduction in wound infections in women who undergo either elective or emergent cesarean delivery [1, 2]. The practice of administration of antimicrobials in cesarean delivery after umbilical cord clamping was common until 2013 [3]. Microbiome building is important for the children’s development. It is modulated and shaped by antibiotic treatment, the birth delivery mode and breastfeeding [5,6,7,8,9]. The World Health Organization (WHO) recommends administration of surgical antimicrobial prophy‐ laxis (SAP) in cesarean section prior to incision to prevent surgical site infections (SSI). This study aimed to determine whether SAP administration following cord clamping confers an increased SSI risk to the mother
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