Preoperative Antibiotic Prophylaxis for Cesarean Delivery Preferred

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Infectious Diseases| February 01 2009 Preoperative Antibiotic Prophylaxis for Cesarean Delivery Preferred AAP Grand Rounds (2009) 21 (2): 15. https://doi.org/10.1542/gr.21-2-15 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Preoperative Antibiotic Prophylaxis for Cesarean Delivery Preferred. AAP Grand Rounds February 2009; 21 (2): 15. https://doi.org/10.1542/gr.21-2-15 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: antibiotic prophylaxis, cesarean section, preoperative care Source: Costantine MM, Rahman M, Ghulmiyah L, et al. Timing of perioperative antibiotics for cesarean delivery: a metaanalysis. Am J Obstet Gynecol. 2008(3);199:301.e1–301.e6; doi: 10.1016/j.ajog.2008.06.077 Investigators from the University of Texas Medical Branch, Galveston, conducted a metaanalysis of the current evidence regarding timing of antibiotic prophylaxis for cesarean section (C-section). A search of the literature in-English was done using PubMed to identify all published studies on the prophylactic use of antibiotics for C-section, using cesarean delivery, antibiotics, prophylactic antibiotics, and timing of antibiotics as key words. Bibliographies of all the relevant articles were reviewed to identify additional references. Only randomized controlled trials (RCT) that compared the use of antibiotics given at cord clamping to antibiotics given preoperatively were included. Outcomes of interest included the rate of post-partum endometritis (primary outcome measure) and wound infection, other post-partum infection, suspected or confirmed neonatal sepsis, and NICU admission. Information about antibiotics used was also collected. More than 280 studies were identified; five trials included a comparison of timing of a single antibiotic dose, three of which were RCTs. The RCTs were all performed between 1996 and 2007 and used cefazolin. These three RCTs comprised the data set for the metaanalysis. A total of 749 women were part of the three RCTs: 377 received antibiotics preoperatively and gave birth to 387 infants while 372 received antibiotics at cord clamping and gave birth to 384 infants. Preoperative antibiotic use resulted in a 53% overall reduction in the risk of postpartum endometritis (RR=0.47; 95% CI, 0.26–0.85; P=.012) and 50% reduction in the total risk of infections (RR=0.50; 95% CI, 0.33–0.78; P=.002) as compared to antibiotic administration at cord clamping. When the non-randomized studies were included the perioperative antibiotic prophylaxis was not as useful. There was also a trend towards lower risk of wound infection. Preoperative administration of antibiotics did not impact rates of proven or suspected neonatal sepsis or NICU admission. The authors conclude that preoperative antibiotic administration in C-section significantly decreases the incidence of postpartum endometritis and total infectious morbidities without affecting neonatal outcomes. Dr. Rathore has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Prophylactic preoperative antibiotics are considered the standard of care and are recommended to prevent postoperative infectious complications.1 The timing of antibiotic use in C-section, however, has been a subject of debate because of the concern that antibiotics administered prior to cord clamping are transplacentally passed to infants and can lead to difficulties in evaluating them for sepsis. As a result, many obstetricians and pediatricians favor the use of prophylactic antibiotics after cord clamping in cesarean deliveries. While this may be beneficial for the infant, it places the mother at risk for postoperative infections, especially endometritis. Because of the lack of sufficiently powered, well-designed studies, the exact timing of antibiotic prophylaxis in C-section has remained an unresolved issue. Costantine, et al have attempted to address this issue by... You do not currently have access to this content.