Antibiotics In Cesarean Section Research Articles

State of the Art: Intrapartum Antibiotics in Cesarean Section—The Infant Microbiota and Allergic Diseases

(Acta Obstet Gynecol Scand. 2023;102:811–820) Recent changes in guidelines for administering maternal antibiotics for cesarean deliveries (CD) have increased neonatal exposure to antibiotics. Potential long-term effects of this exposure are relatively unknown; recent evidence in other fields has indicated a long-lasting impact of antibiotic exposure on gut microbiota composition, which raises concerns about the effects of antibiotics on the fragile and new gut microbiota of neonates around the time of birth. This review assessed the current guidelines and applications for CD antibiotics, as well as discussed the importance of neonatal intestinal microbiota and the potential consequences of antibiotic prophylaxis in the development of the neonatal immune system and allergic disease.

Cost-effectiveness analysis of 2 g of cefazolin compared with 1 g of cefazolin as prophylactic antibiotics in cesarean section at the Mekong Maternity Hospital from 2021 to 2022

Objective: To investigate the cost-effectiveness of using the prophylactic antibiotic cefazolin during cesarean section with a dose of 2 g compared to 1 g by clinical practice at the Mekong Maternity Hospital. Methods: A cost-effectiveness analysis applying a decision tree was conducted to compare the use of cefazolin 2g to cefazolin 1g from a healthcare sector’s perspective. Cost parameters were extracted and calculated from electronic medical records from the Mekong Maternity Hospital, whereas quality-adjusted life-years were derived through literature review. Hospital data were collected retrospectively from January 2021- June 2021 for women prophylactically using 1g of cefazolin and prospectively from January 2022-June 2022 for those treating with 2 g of cefazolin. The Incremental Cost-effectiveness Ratio was estimated to determine whether it is cost-effective between two regimens. Sensitivity analyses were used to examine the robustness of the results. Main findings: The use of 2 g of cefazolin for prophylactic antibiotics in the cesarean section per each woman was less expensive at 28.353.391 VND compared with 28.410.451 VND for the use of 1 g of cefazolin. Also, it was more effective expressed by higher QALYs at 0,9194 versus 0,9154 in case using 1 g of cefazolin, resulting as the dominant regimen. Cefazolin 2g usage gained a 65.9% probability being more cost-effective than 1 g of cefazolin at the willingness to pay threshold of 3GDP per capita. Conclusion: The use of 2 g of cefazolin was likely to be dominant over 1 g of cefazolin pertaining to cost-effectiveness terms as a cesarean delivery infection prophylaxis. Keywords: Cesarean section; cost-effectiveness analysis; cefazolin; different doses; prophylactic antibiotics

Comparative Study of Amoxicillin and Multiple Antibiotics in Caesarean Section

Background: Prophylactic antibiotic usage is important for preventing surgical site wound infections and related complications following caesarean delivery, which can lead to maternal morbidity, prolonged hospital stays, and increased treatment costs. Despite the recommendation for a single dose of preoperative antibiotic prophylaxis, clinicians are hesitant to adopt this approach due to variations in patient characteristics and concerns about aseptic techniques. Objective: To compare the efficacy of a single-antibiotic regimen versus multiple antibiotics in caesarean section procedures. Materials and Methods: It was a randomized clinical trial study. It was carried out in Obs and Gynae, North East Medical College, Sylhet, Bangladesh during the period of January 2022 to June 2022. The study included pregnant women above 34 weeks of gestation admitted to the hospital undergone elective or emergency caesarean delivery for singleton pregnancy. Total 92 sample patients with 46 patients in each group. Study involved two groups. Group A received Amoxicillin single antibiotic. Group B received multiple antibiotics. Statistical data calculations were done using Statistical Package for the Social Science (SPSS Inc., Version 25.0, Chicago, IL, USA) and Chi-square test was done. The p- value <0.05 was considered significant. Results: There were 46 patients in each group. Baseline characteristics, indications for caesarean delivery, duration of operation, duration of hospital stay and difficulties were similar. Post- operative morbidities like wound infection did not differ significantly (P>0.05). None of the women needed prolong hospital stay. Conclusion: The current study found no statistically significant difference in the outcome measures among the two study groups receiving different prophylactic regimens for caesarean delivery. Therefore, it can be concluded that both single and multiple antibiotics provide equally effective protection in reducing maternal .......

State of the art: Intrapartum antibiotics in cesarean section, the infant microbiota and allergic diseases.

With increasing rates of cesarean section worldwide and international guidelines advising pre-incision antibiotics, neonatal exposure to pre-birth antibiotics is higher than ever before. Emerging evidence has raised concern regarding the impact of such antibiotics on the neonatal intestinal microbiota, immune system development and health conditions later in life. This narrative review investigates current protocols for intrapartum prophylactic antibiotics in cesarean section, how this and other factors may affect the neonatal intestinal microbiota and whether intrapartum antibiotics used for cesarean section are linked to the development of allergic disease.

Single Dose Versus Multiple Dose Prophylactic Antibiotics in Cesarean Section in a Tertiary Care Hospital

Introduction: Choice of antibiotics as prophylaxis has become crucial factor for morbidity of women after delivery and neonatal complication associated thereafter. The purpose of this study was to compare the efficacy of single dose versus multiple dose of ceftriaxone in cesarean section (CS). Methods: A prospective experimental study was carried out in Universal College of Medical Sciences and Teaching Hospital, Tribhuvan University, Bhairahawa, from May 2015 to October 2016. One hundred patients who had undergone cesarean section were divided in two groups with fifty in each. Patients in group I were treated with single dose of ceftriaxone, whereas patients in group II were treated with multiple dose of ceftriaxone. The data were analyzed using independent "t" test, chi-square test as appropriate. A p-value of <0.05 was considered significant. Results: The distribution of Emergency CS and Elective CS were 72% and 28% in prophylactic single dose group and 88% and 12% in postoperative multiple dose regime and was statistically non-significant difference between single and multiple dose ceftriaxone. One wound infection was observed in multiple dose ceftriaxone treated women as compared to single dose ceftriaxone treated women. Febrile morbidity (8%) and urinary tract infections (2%) were observed in postoperative multiple dose regimen as compared to prophylactic single dose regimen. Conclusion: Prophylactic single dose of ceftriaxone was effective in reducing infective morbidity in patients with cost benefit, and also reduces chances of drug resistant in future.

Prophylactic antibiotics before cord clamping in cesarean delivery: a systematic review.

The number of clinical trials investigating the optimal timing of prophylactic antibiotics in cesarean section has increased rapidly over the last few years. We conducted a systematic review to inform up-to-date evidence-based guidelines to prevent postpartum infectious morbidity in the mother and rule out any safety issues related to antepartum antibiotic exposure in infants. Four bibliographic databases were searched for published reports of trials. Ongoing or unpublished studies were searched in Clinicaltrials.gov and the World Health Organization registry platform. Randomized controlled trials comparing antibiotic prophylaxis before and after cord clamping in cesarean section were eligible. Maternal and neonatal outcomes were assessed, and certainty of evidence graded. In total, 18 randomized controlled trials met the inclusion criteria. Those women who received antibiotics preoperatively were 28% (relative risk 0.72, 95% confidence interval 0.56-0.92, nine studies, 4342 women, high quality of evidence) less likely to show infectious morbidity as compared with those who received antibiotics after cord clamping. The risk of endomyometritis and/or endometritis was reduced by 43% (relative risk 0.57, 95% confidence interval 0.40-0.82, 13 studies, 6250 women, high quality of evidence) and the risk of wound infection by 38% (relative risk 0.62, 95% confidence interval 0.47-0.81, 14 studies, 6450 women, high quality of evidence) in those who received antibiotics preoperatively as compared to those who received antibiotics after cord clamping. For other maternal infections no significant differences were identified. The risk for neonatal outcomes, such as deaths attributed to infection, sepsis, neonatal antibiotic treatment, intensive care unit admission or antibiotic-related adverse events, was not found to be different, either clinically or statistically, when antibiotics were given before or after cord clamping (moderate to low quality of evidence). The evidence in favor of prophylactic antibiotic administration before, in comparison with after, cord clamping for major maternal infections was of high quality, meaning that further research would be unlikely to change the confidence in these findings. However, we recommend additional research reflecting the precision of the effect estimates for neonatal outcomes.

Timing of antibiotic prophylaxis in cesarean section: retrospective, difference-in-differences estimation of the effect on surgical-site-infection

Background: Cesarean section (CS) is one of the most common surgical procedures performed worldwide. Surgical-site-infection (SSI) occurs in approximately 5–10% of CS. The benefit of prophylactic antibiotics for prevention of SSI has been demonstrated in the literature. The optimal timing of antibiotic prophylaxis (prior to surgical incision versus after cord clamping) was investigated in recent studies. In January 2014, the Israeli Ministry of Health introduced a national quality measure which monitors the administration of prophylactic antibiotics in CS. The custom clinical practice in our medical center was to administer prophylactic antibiotics immediately after cord clamping. Upon introduction of the national quality measurement program, the practice was changed to administration of antibiotics prior to surgical incision. Our objective was to examine the effect of timing of prophylactic antibiotics administration on the incidence of SSI following CS, in a single medical center that performs a large volume of deliveries, with a low rate of CS.Material and methods: Taking advantage of a discrete change in clinical practice, we used retrospective data and applied difference-in-differences design to estimate the effect of the timing of prophylactic antibiotics administration on SSI rates. The analysis included all CSs performed during 2012–2015 and all hysterectomies conducted during the study period.Results: The coverage rates of prophylactic antibiotics in CS before and after the policy change were 99.10% and 99.03%, respectively. The rates of SSI following CS, before and after the policy change, were 2.63% (n = 2499) and 2.32% (n = 3840), respectively. The rates of SSI following hysterectomy, before and after the policy, change were 6.82% (n = 396) and 7.09% (n = 437), respectively. Difference-in-differences (DID) estimates of the effect of policy change on the incidence of SSI in linear and logistic regression models were not significant (B = −0.6%, p = .64; odds ratio = 0.84, p = .58, respectively).Conclusions: We found no effect of the timing of prophylactic antibiotic administration (prior to surgical incision versus after cord clamping) on SSI rates following CS.

Antibiotic prescribing pattern in cesarean section

Use of antimicrobials in caesarean section has become an accepted practice to minimize the incidence of postoperative complications. Not many studies are available in Bangladesh regarding the using pattern of antibiotics in caesarean section. The objectives of the study was to find out the pattern of use of antibiotic prophylaxis in caesarean section and also the frequency of postoperative morbidity. The prospective cross-sectional study included 356 patients undergoing caesarean section in Prime Medical College Hospital, Rangpur and 10 different private clinics in Rangpur city. Patients demographics, perioperative data, antibiotic used with dosage and schedules were recorded. Investigations like pus, blood and urine culture and sensitivity were recorded for patients with postoperative complications. Change of antimicrobial following culture sensitivity report was noted. Most of the patients, 197 (55.3%), came from lower middle socioeconomic status. Major indication of cesarean section was emergency in 314 (88.2%) patients. The use of third generation cephalosporin (ceftriaxone) in majority of the patients, 209 (58.7%), was observed. Two drugs combination commonly included third generation cephalosporin and metronidazole, and in addition gentamicin was added when three drugs combination was used. Fifty five (15.5%) patients had postoperative complications which included fever, wound infection, urinary tract infection and endometritis. The mean duration (SD) of antibiotic administration was 12.4 (3.5) days in infected patients and 8.0 (2.1) days in non-infected patients, and the difference was statistically significant (p < 0.01). The mean duration (SD) of hospital stay was 15.4 (5.5) and 9.1 (3.9) days for infected and non-infected patients, respectively; and the difference was statistically significant (p < 0.01). Isolated micro-organisms from wound infection, urinary tract infection and lochia were gram-negative, and Escherichia coli, 16 (41.0%), was the common which was resistant to third generation cephalosporin and sensitive to amikacin. Obstetricians should utilize clinically effective antibiotics. Whenever possible, single drug rather than combination therapy should be used. Periodic surveillance of antimicrobial prophylaxis is essential to detect the emergence of antibiotic resistance.Mediscope Vol. 3, No. 1: January 2016, Pages 8-15

Pola Penggunaan Antibiotik Profilaksis pada Pasien Bedah Caesar (Sectio Caesarea) di Rumah Sakit Pekanbaru Medical Center (PMC) Tahun 2014

Telah dilakukan penelitian pola penggunaan antibiotik profilaksis pada pasien bedah caesar (Seksio Sesare) di Rumah Sakit Pekanbaru Medical Center (PMC) tahun 2014. Tujuan penelitian ini untuk mengetahui pola penggunaan antibiotik profilaksis bedah sesar. Jenis penelitian yang dilakukan adalah penelitian observasional yang dirancang dengan studi deskriptif dengan cara melakukan kajian terhadap rekam medis pasien yang menggunakan antibiotik profilaksis pada bedah sesar selama bulan Januari sampai dengan bulan Desember 2014. Sampel yang digunakan adalah 73 pasien yang memenuhi kriteria inklusi dengan teknik purposive sampling. Hasil penelitian ini menyatakan bahwa penggunaan antibiotik profilaksis bedah sesar di Rumah Sakit Pekanbaru Medical Center adalah Seftriakson tunggal dengan dosis 1g (58,9%) dan kombinasi Gentamisin (80 mg) dengan Seftriakson (1g) (41,1%), dimana semuanya dalam bentuk obat generik (100%) dengan waktu pemberian antibiotik 0-2 jam sebelum operasi (100%) dengan rute pemberian secara intravena (100%).

A randomized clinical trial evaluating prophylactic single-dose vs prolonged course of antibiotics for caesarean section in a high HIV-prevalence setting

The evidence that perioperative antibiotics for caesarean delivery are effective in reducing infective morbidity is unequivocal. In developing countries, especially those with high HIV-prevalence, clinicians have increasingly become anxious about the efficacy of perioperative antibiotics, hence the adoption of treatment regimens, as described in this study. We set out to investigate if these fears have a basis by conducting a randomised clinical trial. The setting was two tertiary units in a developing country with a significant HIV-prevalence. The outcome measures assessed were: pyrexia, wound infection, admission with puerperal sepsis, laparotomy for pelvic abscess and duration of hospital stay. There was no statistically significant difference between the two arms of the study with regard to the above outcomes. Our conclusion is that the two antibiotic regimens are equivalent in preventing infection, therefore there is no justification for subjecting patients to week-long antibiotics and the unnecessary increase in nurse workload.

Antibiotic Prophylaxis in Caesarean Section

Objective: To study the use of prophylactic antibiotics in caesarean section (CS). Methods: A prospective, cross-sectional study was conducted at Western Regional Hospital of Nepal. Results: This study included a total of 188 eligible women undergoing CS. The result showed that 42.6 % of the women were of 20-24 yrs of age followed by 31.9 % of 25-29 yrs. The indications for CS included cephalopelvic disproportion (62.2 %), oligohydraminos (20.2 %), breech presentation (18.1 %) and fetal distress (10.1 %). Failed induction, multiple pregnancy, failure to progress, dystocia and preeclampsia/eclampsia were relatively rare indications. Elective and emergency CS was common between the age group 20-24 and 25-29 yrs whereas emergency CS was more common than elective in the age group below 20 yrs and above 39 yrs. In 99.5 % cases metronidazole, 50.5 % cases ciprofloxacin and 50.5 % cases gentamycin was used for prophylaxis. Of the total women 50 % of the women got 3 antibiotics for prophylaxis followed by 47.9 % of them who got 2 antibiotics for prophylaxis. The average length of hospital stay was found to be 6.71 days. Conclusion: The results obtained from the study revealed that CS was prevalent in Western region of Nepal. But there was no proper guideline for antibiotic prophylaxis for CS in the hospital. Therefore, there is need of a standard guideline to promote rational use of antibiotics for prophylaxis in CS. Key Words: Caesarean section, Antibiotic prophylaxis, Nepal DOI: http://dx.doi.org/10.11591/ijphs.v1i1.280

A prospective multicenter randomized study on prophylactic antibiotics use in cesarean section performed at tertiary center

Objective: To determine whether the duration and timing of prophylactic antibiotics influence maternal postoperative infectious morbidity in cesarean section performed at tertiary center. Methods: This study was a prospective, randomized trial. Pregnant women who underwent cesarean section between December 2008 and September 2009 at tertiary center were enrolled and divided into two groups: Group A, antibiotic prophylaxis was applied for 24 hours and Group B, antibiotic prophylaxis was applied for 48 hours. First generation of cephalosporin was administrated within 30 minutes prior skin incision or after cord clamping. The occurrence of postoperative infectious morbidity such as febrile morbidity, wound infection, endometritis, urinary track infection, pneumonia, sepsis and pelvic abscess and hospital stays were compared. Results: There were 413 pregnant women enrolled and then randomized into 220 for group A and 197 for group B. No demographic differences were observed between two groups. The infectious morbidity was 1.9% (8/413) and wound infection was the most common postoperative infections morbidity. No significant difference was found between the groups for infectious morbidity and hospital stays. Also timing of prophylactic antibiotics did not result in significant difference for infectious morbidity. Conclusion: Short course of prophylactic antibiotics has been shown to be as efficacious as multidose of prophylactic antibiotics for preventing infectious morbidity in cesarean section and timing did not influence on infections morbidity. Further studies focusing on duration and timing of prophylactic antibiotics for cesarean section are needed.

Is obstetric practice in SE Nigeria based on reliable research?

Systematic reviews of randomized controlled trials are used to inform obstetric practice worldwide. It is not known whether obstetric practice in Nigeria currently follows best evidence. This study explored whether the practices in selected hospitals in Nigeria are consistent with available evidence. In Cross River State, 13 health facilities were studied through audit of case notes augmented with exit interviews with postpartum women. Sequential case notes (n=487) were audited and 113 postpartum women were interviewed. For practices where there is good evidence of benefit, routine use varied: antibiotics for pre-term rupture of membrane (83.3% n=6); partograph in monitoring labour (42% n=487); and prophylactic antibiotics for caesarean section (21.5% n=111). Practices with little evidence of benefit were commonly performed: pubic shaving (70.8% n=72); restriction of mobility (33.3% n= 2); supine position for the second stage of labour (97.2% n=72); and episiotomy (37.5% n=72) overall and 74% in primigravidae. Only 33.3% of women were allowed fluids during labour; and diazepam rather than magnesium sulphate was the drug of choice for treating eclampsia. This study demonstrates that a gap exists between best practice guided by reliable research evidence and current obstetric practice in health facilities in the hospitals studied.

Decision analytical economic modelling within a Bayesian framework: application to prophylactic antibiotics use for caesarean section.

Economic evaluation of health care interventions based on decision analytic modelling can generate valuable information for health policy decision makers. However, the usefulness of the results obtained depends on the quality of the data input into the model; that is, the accuracy of the estimates for the costs, effectiveness, and transition probabilities between the different health states of the model. The aim of this paper is to review the use of Bayesian decision models in economic evaluation and to demonstrate how the individual components required for decision analytical modelling (i.e., systematic review incorporating meta-analyses, estimation of transition probabilities, evaluation of the model, and sensitivity analysis) may be addressed simultaneously in one coherent Bayesian model evaluated using Markov Chain Monte Carlo simulation implemented in the specialist Bayesian statistics software WinBUGS. To illustrate the method described, a simple probabilistic decision model is developed to evaluate the cost implications of using prophylactic antibiotics in caesarean section to reduce the incidence of wound infection. The advantages of using the Bayesian statistical approach outlined compared to the conventional classical approaches to decision analysis include the ability to: (i) perform all necessary analyses, including all intermediate analyses (e.g., meta-analyses) required to derive model parameters, in a single coherent model; (ii) incorporate expert opinion either directly or regarding the relative credibility of different data sources; (iii) use the actual posterior distributions for parameters of interest (opposed to making distributional assumptions necessary for the classical formulation); and (iv) incorporate uncertainty for all model parameters.

Randomised trial of educational visits to enhance use of systematic reviews in 25 obstetric units

Objective To evaluate the effectiveness of an educational visit to help obstetricians and midwives select and use evidence from a Cochrane database containing 600 systematic reviews.Design Randomised single blind controlled...

Utilization of antibiotics in caesarean section: A multicentre study

AbstractThis is a prospective multicentre study on patients undergoing Caesarean section, to compare the use of antibiotics in surgery, in four selected countries. Patients admitted within a 6‐month period in each centre were included. Study days were 6 days a month and were taken randomly from all working days in a month. Antibiotic use was recorded pre‐ and post‐operatively. The most commonly used antibiotic in all countries was ampicillin, except in China. Mode of the number of antibiotics used as prophylactic was 1 in India and Nepal, 2 in China and 3 in Indonesia. Duration of antibiotic(s) use was 7–8 days in all countries. Antibiotic prophylaxis for Caesarean section was used improperly, especially in respect to the number, duration and kind of antibiotic given.

Prophylactic antibiotics for caesarean section and hysterectomy

Prophylactic antibiotics for caesarean section and hysterectomy

Routine antibiotics for caesarean section.

Routine antibiotics for caesarean section.

Perioperative short-term prophylaxis with antibiotics in caesarean section

Perioperative short-term prophylaxis with antibiotics in caesarean section

The efficacy of prophylactic antibiotics in cesarean section

The objective of this investigation was to determine the effectiveness of cefazolin-cephalothin administration as a prophylactic regime in patients undergoing cesarean section. The study was to randomized, double-blind, placebo-controlled investigation. Cefazolin, 1.0 gm, or placebo was administered intramuscularly on call to the operating room, and cephalothin, 2.0 gm, or placebo was administered intravenously at 6, 12, and 24 hours postoperatively. Ninety-five patients were included in the study with 49 in the placebo group and 46 in the drug group. Nineteen patients developed 28 infections in the placebo group while eight patients developed eight infections in the drug group (P = <0.05). Eight patients in the placebo group developed infections at two or more sites whereas no patient in the drug-treated group developed multiple infections. No infant developed infection and no overgrowth of bacteria occurred. This study supports the concept of preoperative antibiotic administration being beneficial to the obstetric patient.