Quel est le moment optimal de l’antibioprophylaxie pour césarienne élective, avant l’incision cutanée ou après clampage du cordon ombilical ? Étude prospective randomisée

Abstract

To compare the effect of antibiotics prophylaxis within 30mins before skin incision (A) and after umbilical cord clamping (C) on the incidence of postoperative infections in patients undergoing elective caesarean section at Farhat Hached university teaching hospital. We conducted a randomised clinical trial evaluating 279patients undergoing elective caesarean section. Patients were randomly assigned a group number that allocated them to either arm of the study. They received the same prophylactic antibiotic (cefazol® 2g) according to their allotment. They were followed up to detect infection up to 30days postoperatively. The primary outcome was postoperative infection. The data collected were analysed with SPSS version18.0using univariate and bivariate analysis. The risk of overall postoperative infection was not significantly lower when prophylaxis was given before skin incision (4.37% (A) vs 9.85% (C); P=0.07; OR=0.42 [0.15-1.12]). We also found wound infections to be significantly reduced in the pre-incision group (2.2% [A] vs 8.45% [C]; P=0.03; OR=0.24 [0.06-0.88]). However, there was no difference in the endometritis infectious. On the other hand, there was no negative impact on the neonatal features. Giving prophylactic antibiotics before skin incision reduces risk of postoperative infection, in particular of wound infections.