Abstract
BackgroundCesarean surgical site infections (SSIs) can be prevented by proper preoperative antibiotic prophylaxis. Differences in antibiotic selection in clinical practice exist according to obstetricians’ preferences despite clear guidelines on preoperative antibiotic prophylaxis. This study aimed to compare the efficacy of ampicillin and ceftriaxone in preventing cesarean SSIs.MethodsThe observational prospective cohort study was conducted at a tertiary hospital in Thailand from 1 January 2007 to 31 December 2012. Propensity scores for ceftriaxone prophylaxis were calculated from potential influencing confounders. The cesarean SSI rates of the ceftriaxone group vs. those of the ampicillin prophylactic group were estimated by multilevel mixed-effects Poisson regression nested by propensity score.ResultsData of 4149 cesarean patients were collected. Among these, 911 patients received ceftriaxone whereas 3238 patients received ampicillin as preoperative antibiotic prophylaxis. The incidence of incisional SSIs was (0.1% vs. 1.2%; p = 0.001) and organ space SSIs was (1.2% vs. 2.9%; p = 0.003) in the ceftriaxone group compared with the ampicillin group. After adjusting for confounders, the rate ratios of incisional and organ/space SSIs in the ceftriaxone compared with the ampicillin group did not differ (RR, 0.23; 95% CI 0.03–1.78), and (RR, 1.62; 95% CI 0.83–3.18), respectively.ConclusionThese data indicate no difference exists between ampicillin and ceftriaxone to prevent SSIs after cesarean section. Ampicillin may be used as antibiotic prophylaxis in cesarean section.
Highlights
Cesarean surgical site infections (SSIs) can be prevented by proper preoperative antibiotic prophylaxis
24 received antibiotics other than ampicillin and ceftriaxone as preoperative prophylaxis, 345 patients received improper antibiotic-administration time and 470 patients presented rupture of the membranes (ROM) > 18 h accompanied by fever before the cohort zero-th time, and all were excluded from the study (Fig. 1)
After adjusting for propensity scores and other confounding factors included age, being referred, education level, body weight, being an ethnic minority, anemia, pelvic examination more than 4 before cesarean section, being preterm, wound class 3 or more, presence of foulsmelling amniotic fluid, longer than 55-min operative time, emergency operation, American Society of Anesthesiology (ASA)-score of 3 or more, being primigravida, estimated blood loss, skin incision line and addition procedures; rate ratios with 95% confidence interval of total cesarean Surgical site infections (SSIs), incisional SSIs and organ/ space SSIs in the ceftriaxone group compared with the ampicillin group were 1.10; 95% CI 0.58–2.08, 0.23; 95% CI 0.03–1.78 and 1.62; 95% CI 0.83–3.18, respectively (Table 4)
Summary
Cesarean surgical site infections (SSIs) can be prevented by proper preoperative antibiotic prophylaxis. Differences in antibiotic selection in clinical practice exist according to obstetricians’ preferences despite clear guidelines on preoperative antibiotic prophylaxis. Surgical site infections (SSIs) occurring after this operation were estimated at 1.5 to 3.8% in the USA [3] and 0.9% in Thailand [4]. A single 1-g intravenous dose of cefazolin [12] or at a higher dose of 2-g [9] is recommended as the first-line preoperative antibiotic of Assawapalanggool et al Antimicrobial Resistance and Infection Control (2018) 7:13 choice for cesarean patients. In spite of clear guidelines on preoperative antibiotic prophylaxis, differences in clinical practices remain, depending on obstetricians’ preference. Ceftriaxone and ampicillin have been prescribed in our setting and some others in Thailand
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
