Abstract

Background: Norwegian guidelines recommend prophylactic antibiotic use for all acute caesarean section (CS), while administered on indications such as long duration of surgery/severe bleeding in elective CS, and differ from Cochrane recommendations, which advocate prophylactic use at start of surgery in all CS. Objectives: To explore completeness of reporting, compliance with guidelines and the effect of prophylactic antibiotics on surgical site infections (SSIs) in women having CS. Methods: Data sources were the Medical Birth Registry, Norway, and the Norwegian Surveillance system for surgical site infections (NOIS). CS comprises one of five major surgeries included in active post-discharge surveillance (PDS) of 30 days, from September 1st through November 30th, on annual basis. CDC definitions of infectious outcomes are applied. Results: The number of hospitals reporting on CS to NOIS increased from 20 in 2005 to 37 hospitals in 2008, representing 43% and 85% of the national volume of surgery, respectively. Completeness of 25 days PDS varied between 86–91%. SSIs remained stable with an incidence of 6% for wound infections, and 1–2% incidence of organ/space infections. Most wound infections were diagnosed after discharge (>80%), whereas more deep organ/space infections were diagnosed during hospital stay (>60%). Prophylactic antibiotics were applied in nearly 30% and 78% of elective and acute CS, respectively, with no major differences in incidence of SSIs by prophylactic use (inconsistent results). Conclusions: Completeness of reporting and compliance on active 30-days PDS are considered high. Infection rates remain low with no major difference in elective/acute surgery by use of prophylactic antibiotics.

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