Postcesarean Infection Research Articles

Overuse of prophylactic antibiotics for elective caesarean delivery in Medani Hospital, Sudan

Background: Antibiotics for prophylaxis are widely used to reduce the risk of post-caesarean delivery infection. The dosage regimens are often inappropriate and may result in the appearance of drug-resistant organisms, which will increase the cost.Objectives: A cross-sectional study was conducted to investigate the prescribing patterns of prophylactic antibiotics for elective caesarean delivery (CD) at Medani Hospital, Sudan.Method: The medical records of women who underwent elective CD from April 2015 to June 2015 were reviewed retrospectively.Results: The main reasons for CD among these women (n=202) were repeat CD, breech and antepartum haemorrhage. The mean (±SD) age of the women was 28.7 (±6.2) years. Ceftizoxime was the most commonly prescribed antibiotic, prescribed for 63.9% of women. It was used alone in 12.4% of cases, and in combination with gentamicin and metronidazole in 49.5% of cases. Cefuroxime was used in combination with gentamicin and metronidazole in 26.7% of women, and in combination with metronidazole only in 9.4% of women, making the overall percentage 36.1%. Antibiotics were administered for 5 days in 32.7% of cases. 91.1% of women received antibiotic prophylaxis after clamping of the cord. All women received oral antibiotic prophylaxis on discharge for five to seven days. Oral cefuroxime in combination with metronidazole was the most preferred regime (77.2 %).Conclusions: The current study shows overuse of antibiotics for elective CD. Injectable ceftizoxime in combination with gentamicin and metronidazole after cord clamping was the most commonly prescribed regime.

Risk Factors for Postcesarean Maternal Infection in a Trial of Extended-Spectrum Antibiotic Prophylaxis.

To identify maternal clinical risk factors for postcesarean maternal infection in a randomized clinical trial of preincision extended-spectrum antibiotic prophylaxis. We conducted a planned secondary analysis of a randomized clinical trial. Patients were 24 weeks of gestation or greater and delivered by cesarean after a minimum of 4 hours of ruptured membranes or labor. All participants received standard preincision prophylaxis and were randomized to receive azithromycin or placebo. The primary outcome for this analysis is maternal infection: a composite outcome of endometritis, wound infection (superficial or deep), or other infections occurring up to 6 weeks postpartum. Maternal clinical characteristics associated with maternal infection, after controlling for azithromycin assignment, were identified. These maternal factors were included in a multivariable logistic regression model for maternal infection. Of 2,013 patients, 1,019 were randomized to azithromycin. Overall, 177 (8.8%) had postcesarean maternal infection. In the final adjusted model, compared with the reference groups, women of black race-ethnicity, with a nontransverse uterine incision, with duration of membrane rupture greater than 6 hours, and surgery duration greater than 49 minutes, were associated higher odds of maternal infection (all with adjusted odds ratios [ORs] of approximately 2); azithromycin was associated with lower odds of maternal infection (adjusted OR 0.4, 95% confidence interval 0.3-0.6). Despite preincision azithromycin-based extended-spectrum antibiotic prophylaxis, postcesarean maternal infection remains a significant source of morbidity. Recognition of risk factors may help guide innovative prevention strategies. ClinicalTrials.gov, https://clinicaltrials.gov, NCT012235546.

Risk Factors for Sepsis Following Cesarean Section in Ulaanbaatar: A Case-Control Study

Objectives: The aim of this study was to determine the incidence of post-cesarean sepsis in patients undergoing a cesarean section (CS) and to identify risk factors and the impact of antibiotic prophylaxis on this condition. Methods: All cesarean deliveries performed at Ulaanbaatar Urguu Maternity Hospital and National Center for Maternal and Child Health (NCMCH) from October 1st 2013 to October 1st 2015 were evaluated for sepsis, based on criteria established by Centers for Disease Control and Prevention’s National Healthcare Safety Network (CDC/NHSN). Medical records of case study and control patients were reviewed when they had post operation infection and revisited the hospital. Records were also compared to and included sociodemographic and clinical characteristics. Results: Overall findings were: 47.4% (361/ 761) of cases were complicated by wound infection and the control group without wound infections was 52.6% (400/761). Post-cesarean wound infection risk factors were statistically determined by: 1) emergency surgery (95% CI=2.8; P=0.35); 2) Twin pregnancy (95% CI=5.8; P=0.2); 3) Premature rupture of membrane (95% CI=6.4; P=0.26) and; 4) Failed induction (95% CI=4.6; P=0.5). Conclusion: Identifying high-risk patients who will require intensive postoperative care is critical in reducing incidences of post-cesarean wound infection.

Postcesarean wound infection: prevalence, impact, prevention, and management challenges.

Surgical site infection (SSI) is one of the most common complications following cesarean section, and has an incidence of 3%–15%. It places physical and emotional burdens on the mother herself and a significant financial burden on the health care system. Moreover, SSI is associated with a maternal mortality rate of up to 3%. With the global increase in cesarean section rate, it is expected that the occurrence of SSI will increase in parallel, hence its clinical significance. Given its substantial implications, recognizing the consequences and developing strategies to diagnose, prevent, and treat SSI are essential for reducing postcesarean morbidity and mortality. Optimization of maternal comorbidities, appropriate antibiotic prophylaxis, and evidence-based surgical techniques are some of the practices proven to be effective in reducing the incidence of SSI. In this review, we describe the biological mechanism of SSI and risk factors for its occurrence and summarize recent key clinical trials investigating preoperative, intraoperative, and postoperative practices to reduce SSI incidence. It is prudent that the surgical team who perform cesarean sections be familiar with these practices and apply them as needed to minimize maternal morbidity and mortality related to SSI.

Reducing post-cesarean wound infection at Muhororo Hospital by increasing hand hygiene practice

Purpose Post-cesarean wound infection (PCWI) is a common post-operative complication that can negatively affect patients and health systems. Poor hand hygiene practice of health care professionals is a common cause of PCWI. This case study aims to describe how strategic problem solving was used to introduce an alcohol-based hand rub in a district hospital in Rwanda to improve hand hygiene compliance among health care workers and reduce PCWI. Design/methodology/approach Pre- and post-intervention study design was used to address the poor hand hygiene compliance in the maternity unit. The hospital availed an alcohol-based hand rub and the team provided training on the importance of hand hygiene. A chart audit was conducted to assess the PCWI, and an observational study was used to assess hand hygiene compliance. Findings The intervention successfully increased hand hygiene compliance of health care workers from 38.2 to 89.7 per cent, p < 0.001, and was associated with reduced hospital-acquired infection rates from 6.2 to 2.5 per cent, p = 0.083. Practical implications This case study describes the implementation process of a quality improvement project using the eight steps of strategic problem solving to introduce an alcohol-based hand rub in a district hospital in Rwanda. The intervention improved hand hygiene compliance among health care workers and reduced PCWI using available resources and effective leadership skills. Originality/value The results will inform hospitals with similar settings of steps to create an environment that enables hand hygiene practice, and in turn reduces PCWI, using available resources and strategic problem solving.

Routes of administration of antibiotic prophylaxis for preventing infection after caesarean section.

Post-caesarean section infection is a cause of maternal morbidity and mortality. Administration of antibiotic prophylaxis is recommended for preventing infection after caesarean delivery. The route of administration of antibiotic prophylaxis should be effective, safe and convenient. Currently, there is a lack of synthesised evidence regarding the benefits and harms of different routes of antibiotic prophylaxis for preventing infection after caesarean section. The aim of this review was to assess the benefits and harms of different routes of prophylactic antibiotics given for preventing infectious morbidity in women undergoing caesarean section. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2016), ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (6 January 2016) and reference lists of retrieved studies. We included randomised controlled trials (RCTs) comparing at least two alternative routes of antibiotic prophylaxis for caesarean section (both elective and emergency). Cross-over trials and quasi-RCTs were not eligible for inclusion. Two review authors independently assessed trials for inclusion, assessed the risk of bias and extracted data from the included studies. These steps were checked by a third review author. We included 10 studies (1354 women). The risk of bias was unclear or high in most of the included studies.All of the included trials involved women undergoing caesarean section whether elective or non-elective. Intravenous antibiotics versus antibiotic irrigation (nine studies, 1274 women) Nine studies (1274 women) compared the administration of intravenous antibiotics with antibiotic irrigation. There were no clear differences between groups in terms of this review's maternal primary outcomes: endometritis (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.70 to 1.29; eight studies (966 women) (low-quality evidence)); wound infection (RR 0.49, 95% CI 0.17 to 1.43; seven studies (859 women) (very low-quality evidence)). The outcome of infant sepsis was not reported in the included studies.In terms of this review's maternal secondary outcomes, there were no clear differences between intravenous antibiotic or irrigation antibiotic groups in terms of postpartum febrile morbidity (RR 0.87, 95% CI 0.48 to 1.60; three studies (264 women) (very low-quality evidence)); or urinary tract infection (RR 0.74, 95% CI 0.25 to 2.15; five studies (660 women) (very low-quality evidence)). In terms of adverse effects of the treatment on the women, no drug allergic reactions were reported in three studies (284 women) (very low-quality evidence), and there were no cases of serious infectious complications reported (very low-quality evidence). There was no clear difference between groups in terms of maternal length of hospital stay (mean difference (MD) 0.28 days, 95% CI -0.22 to 0.79 days, (random-effects analysis), four studies (512 women). No data were reported for the number of women readmitted to hospital. For the baby, there were no data reported in relation to oral thrush, infant length of hospital stay or immediate adverse effects of the antibiotics on the infant. Intravenous antibiotic prophylaxis versus oral antibiotic prophylaxis (one study, 80 women) One study (80 women) compared an intravenous versus an oral route of administration of prophylactic antibiotics, but did not report any of this review's primary or secondary outcomes. There was no clear difference between irrigation and intravenous antibiotic prophylaxis in reducing the risk of post-caesarean endometritis. For other outcomes, there is insufficient evidence regarding which route of administration of prophylactic antibiotics is most effective at preventing post-caesarean infections. The quality of evidence was very low to low, mainly due to limitations in study design and imprecision. Furthermore, most of the included studies were underpowered (small sample sizes with few events). Therefore, we advise caution in the interpretation and generalisability of the results.For future research, there is a need for well-designed, properly-conducted, and clearly-reported RCTs. Such studies should evaluate the more recently available antibiotics, elaborating on the various available routes of administration, and exploring potential neonatal side effects of such interventions.

Ventilation of Preterm Infants during Delayed Cord Clamping (VentFirst): A Pilot Study of Feasibility and Safety.

Background Establishing lung inflation prior to umbilical cord clamping may improve the cardiovascular transition and reduce the risk of intraventricular hemorrhage in preterm infants. We developed a pilot feasibility and safety study in which infants < 33 weeks' gestation received assisted ventilation during delayed cord clamping (DCC). Methods Infants born between 24 0/7 and 32 6/7 weeks' gestation whose mothers consented were enrolled. All infants received continuous positive airway pressure or positive pressure ventilation during 90 seconds of DCC. Outcomes included feasibility (ability to complete protocol and maintain a sterile field during cesarean deliveries) and safety variables (Apgar scores, umbilical cord pH and base deficit, admission temperature, and postcesarean infection). Results A total of 29 infants were enrolled, including one set of twins (median gestation: 30 weeks; 72% cesarean births). In all cases, the protocol was completed. Heart rate at 60 seconds was more than 100 beats per minute in all infants. Apgar scores, cord blood gas values, and admission temperature were comparable to other preterm deliveries at our institution. Conclusion Assisting ventilation of very preterm infants during 90 seconds of DCC is challenging but feasible and appears to be safe in this small pilot study. A randomized clinical trial is warranted to determine clinical benefit.

Extreme Obesity and Postcesarean Wound Complications in the Maternal-Fetal Medicine Unit Cesarean Registry.

The objective of this study was to estimate the association between obesity and wound complications after cesarean delivery. A secondary cohort analysis of the Maternal-Fetal Medicine Unit Cesarean Registry. We stratified the exposure, maternal body mass index (BMI) at delivery, as not obese (BMI < 30), obese (BMI 30-45), and extremely obese (BMI > 45). Our primary outcome was wound complication composite of wound infection, endometritis, wound opening, seroma/hematoma, and hospital readmission. Our secondary outcomes included infection composite (wound infection and endometritis) and each individual outcome included in the primary composite. We performed unadjusted and multivariable logistic regression analyses. We included 38,229 women who underwent cesarean; 39% were not obese, 55% were obese, and 6% were extremely obese. In our cohort, 40% of women underwent repeat cesarean and 57% underwent cesarean after labor. Extremely obese women had increased risk for any wound complication (14%, adjusted odds ratio [AOR], 1.65; 95% confidence interval [CI], 1.44-1.89), endometritis (8.3%, AOR, 1.26; 95% CI, 1.07-1.49), wound infection (2.0%, AOR, 3.77; 95% CI, 2.60-5.46), wound opening (0.8%, AOR, 5.47; 95% CI, 2.79-10.71), and wound infection-related hospital readmission (3.6%, AOR, 2.97; 95% CI, 2.26-3.91) compared with nonobese women. Obese women had increased risk for any wound complication (9.6%, AOR, 1.14; 95% CI, 1.06-1.23) and postcesarean infection (7.7%, AOR, 1.12; 95% CI, 1.03-1.22) but not other outcomes. In a large multicenter cohort study, we found that extreme obesity was associated with substantial increase in maternal postcesarean complications, and the association between obesity and postcesarean complications appears dose related. These findings validate associations found in single-center studies.

Postcesarean section wound infection caused by Mycobacterium massiliense.

Mycobacterium abscessus subsp. massiliense (a subspecies of the M. abscessus complex) is a rare causative agent of surgical site infection after cesarean section (C section). We tried to seek the common source of infection and unravel the optimal treatment modalities. From September 2009 to October 2012, four postpartum women developed C-section wound infections caused by M. massiliense. Speciation of the four isolates was identified using of hsp65, rpoB, and secA1 partial gene sequencing and the Basic Local Alignment Search Tool. The erm(41) and rrl genes were detected for the possibility of inducible macrolide resistance. Pulsed-field gel electrophoresis was used as a tool of molecular epidemiology. All patients underwent intensive intravenous and oral antimycobacterial regimens. Of these patients, three underwent debridement at least once. All four isolates were identified as M. abscessus subsp. massiliense. All of the isolates harbored a truncated erm(41) gene without rrl gene mutations, which explains the susceptibility to clarithromycin and azithromycin. Three isolates were indistinguishable by DNA strain typing, and the fourth strain was clonal with the other three strains. Their infections were not improved in spite of teicoplanin treatment initially. These patients underwent antimycobacterial regimens with/without surgery and were all cured. Teicoplanin treatment failure, painful cutaneous nodules, and persistent wound drainage alerted us to the possibility of nontuberculous mycobacterial skin and soft tissue infection. Accurate identification of subspecies, detection of drug resistance genes, susceptibility testing, and optimal antimycobacterial agents with/without surgical debridement are warranted for successful treatment.

Reducing Infection Rates after Cesarean Birth

<h2>Poster Presentation</h2><h3>Purpose for the Program</h3> The purpose of this innovative educational program was to implement changes to reduce the rate of infection after cesarean at a Midwestern regional health care facility. From 2011 to 2013, this rate ranged from 0.62% to 1.23%. Clearly, there is an upward trend in the rate of infection that needs to be managed to decrease postoperative infections. <h3>Proposed Change</h3> To implement standardized preoperative and postoperative education for all women who have cesarean births. <h3>Implementation, Outcomes, and Evaluation</h3> The interdisciplinary, evidence‐based practice (EBP) project involved physicians, nurses, and staff in obstetric offices and nurses and educators in the labor and delivery and postpartum units. A retrospective chart review was conducted of women who experienced infections after cesarean for 99 variables. No common variables were identified regarding etiology of postcesarean delivery infections. A review of the literature was conducted, and patient education was identified as an intervention that affected infection rates. The interdisciplinary team created standardized preoperative instructions and standardized postoperative instructions that include an educational pamphlet and DVD. The projected program outcome is a decrease in the rate of infection after cesarean at the facility. Project outcomes will be measured by tracking infection rates quarterly and yearly. Preimplementation and postimplementation outcome data will be compared. <h3>Implications for Nursing Practice</h3> It is important that nurses are educated on how to identify best practices to provide consistent education to women from the time they decide on cesarean birth to discharge. It is imperative that nurses know how to implement best practices to improve patient outcomes. Reduced rates of infection will also reduce cost and morbidity associate with cesareans.

Silver Ion-Eluting Dressings for Prevention of Post-Cesarean Wound Infection: A Randomized, Controlled Trial

Silver Ion-Eluting Dressings for Prevention of Post-Cesarean Wound Infection: A Randomized, Controlled Trial

Evaluating Pre-Incision Versus Post Umbilical Cord Clamping Antibiotic Prophylaxis in the Prevention of Post Caesarean Section Infections in a Nigerian Specialist Teaching Hospital.

: Introduction : Caesarean delivery is the single most important factor associated with post partum infection and carries a 5-20 fold increased risk of infection compared to vaginal delivery. With the increase in Caesarean delivery rates worldwide, post-Caesarean delivery infections are likely to become a significant health and economic burden. Pre-incision antibiotic prophylaxis prevents maternal infectious morbidity without prejudice to neonatal infectious morbidity. This Study compared pre-incision versus post-umbilical cord clamping antibiotic prophylaxis in the prevention of post caesarean section infection. Methods : This is an interventional, single blinded, two-armed, randomized, single centre study using amoxicillin/ clavulanic acid plus metronidazole. One hundred and fifty patients that met the inclusion criteria were randomised into pre-incision and post umbilical clamp arm with seventy five patients in each study arm. Patients were followed up for six weeks postpartum. Results : The overall post-operative fever rate was 10.7% with 4.00% in pre-incision and 6.67% in post umbilical clamp group (fisher’s exact test of 0.428 and cumulative incidence relative risk of 0.533 (95%CL: 0.194-1.64). Two percent and 4.67% of studied population developed endometritis in pre-incision and post umbilical groups respectively (fisher’s exact test of 0.327 and cumulative incidence relative risk of 0.44(95%CL: 0.101-1.625). Superficial wound infection occurred in 2.00% of the studied population in pre-incision group and 3.33% in post umbilical group. The overall wound infection prevalence rate was therefore 5.33% (fisher’s exact test of 0.719 and cumulative incidence relative risk of 0.66 (95%CL: 0.395-7.446). Staphylococcus aureus was the commonest isolate. No significant difference between the study groups in this study in terms of neonatal outcome. Conclusion/Recommendation : Antimicrobial agent for surgical prophylaxis could prevent surgical site infection and related morbidity, reduce the duration of hospital stay and therefore cost of health care. Post caesarean section infectious surveillance should be encouraged in all delivery units.

Prophylactic use of negative pressure wound therapy after cesarean delivery.

To evaluate the economic benefit of prophylactic negative pressure wound therapy on a closed laparotomy incision after cesarean delivery in comparison with standard postoperative dressing. We designed a decision-analytic model from a third-party payer's perspective to determine the cost-benefit of prophylactic application of negative pressure wound therapy compared with standard postoperative dressing on a closed laparotomy incision after cesarean delivery. Our primary outcome measure was the expected value of the cost per strategy. Baseline probabilities and cost assumptions were derived from published literature. We conducted sensitivity analyses using both deterministic and probabilistic models. Cost estimates reflect 2014 U.S. dollars. Under our baseline parameters, standard postoperative dressing was the preferred strategy. Standard postoperative dressing and prophylactic negative pressure wound therapy cost $547 and $804 per strategy, respectively. Sensitivity analyses showed that prophylactic negative pressure wound therapy can be cost-beneficial if it is priced below $192; standard postoperative dressing is the preferred strategy among patients with surgical site infection rate of 14% or less. If surgical site infection rates are greater than 14%, prophylactic negative pressure wound therapy could be cost-beneficial depending on the degree of reduction in surgical site infections. At a surgical site infection rate of 30%, the rate must be reduced by 15% for negative pressure wound therapy to become the preferred strategy. Monte Carlo simulation of 1,000 patients in 1 million trials showed that standard postoperative dressing was the preferred cost-beneficial strategy with a frequency of 85%. Our cost-benefit analysis provides economic evidence suggesting that negative pressure wound therapy should not be used on closed laparotomy incisions of patients with low risk of postcesarean delivery surgical site infections. However, among patients with a high risk of surgical site infections, prophylactic negative pressure wound therapy is potentially cost-beneficial.

Skin preparation for preventing infection following caesarean section.

The risk of maternal mortality and morbidity (particularly postoperative infection) is higher for caesarean section than for vaginal birth. With the increasing rate of caesarean section, it is important that the risks to the mother are minimised as far as possible. This review focuses on different forms and methods for preoperative skin preparation to prevent infection. To compare the effects of different agent forms and methods of preoperative skin preparation for preventing postcaesarean infection. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (26 June 2014) and the reference lists of all included studies and review articles. Randomised and quasi-randomised trials, including cluster-randomised trials, evaluating any type of preoperative skin preparation agents, forms and methods of application for caesarean section. Three review authors independently assessed all potential studies for inclusion, assessed risk of bias and extracted the data using a predesigned form. Data were checked for accuracy. We included six trials with a total of 1522 women. No difference was found in the primary outcomes of either wound infection or endometritis. Two trials of 1294 women, compared drape with no drape (one trial using iodine and the other using chlorhexidine) and found no significant difference in wound infection (risk ratio (RR) 1.29; 95% confidence interval (CI) 0.97 to 1.71). One trial of 79 women comparing alcohol scrub and iodophor drape with iodophor scrub without drape reported no wound infection in either group. One trial of 50 women comparing parachlorometaxylenol plus iodine with iodine alone reported no significant difference in wound infection (RR 0.33; 95% CI 0.04 to 2.99).Two trials reported endometritis, one trial comparing alcohol scrub and iodophor drape with iodophor scrub only found no significant difference (RR 1.62; 95% CI 0.29 to 9.16). The other trial of 50 women comparing parachlorometaxylenol plus iodine with iodine alone reported no significant difference in endometritis (RR 0.88; 95% CI 0.56 to 1.38). One trial of 60 women comparing chlorhexidine gluconate with povidone-iodine reported significant lower rates of bacterial growth at 18 hours after caesarean section (RR 0.23, 95% CI 0.07 to 0.70). No difference was found in the secondary outcome of either length of stay or reduction of skin bacteria colony count. No trial reported other maternal outcomes, i.e. maternal mortality, repeat surgery and re-admission resulting from infection. One trial, which was only available as an abstract, investigated the effect of skin preparation on neonatal adverse events and found cord blood iodine concentration to be significantly higher in the iodine group.Most of the risk of bias in the included studies was unclear in selection bias and attrition bias. The quality of the evidence using GRADE was low for wound infection comparing drape versus no drape, one-minute alcohol scrub with iodophor drape versus five-minute iodophor scrub without drape, and parachlorometaxylenol with iodine versus iodine alone. The quality of the evidence for wound infection comparing chlorhexidine gluconate with povidone-iodine was very low. This review found that chlorhexidine gluconate compared with iodine alone was associated with lower rates of bacterial growth at 18 hours after caesarean section. However, this outcome was judged as very low quality of evidence. Little evidence is available from the included randomised controlled trials to evaluate different agent forms, concentrations and methods of skin preparation for preventing infection following caesarean section. Therefore, it is not yet clear what sort of skin preparation may be most efficient for preventing postcaesarean wound and surgical site infection.There is a need for high-quality, properly designed randomised controlled trials with larger sample sizes in this field. High priority questions include comparing types of antiseptic (especially iodine versus chlorhexidine), the timing and duration of applying the antiseptic (especially previous night versus day of surgery, and application methods (scrubbing, swabbing and draping).

Comparison between Azithromycin and Cephalexin for Preventing Infection after Cesarean Section in Obese Patient

Introduction: Postcesarean infection can cause maternal mortality and morbidity. Use of prophylactic antibiotics could decrease surgical site infection. Despite using prophylactic antibiotics in obese women, compared to normal weighted women the rate of wound infection is higher in this group. The aim of this study is to compare prophylactic effect of azithromycin and cephalexin on febrile morbidity and postcesarean infection in women with BMI > 30. Methods and Materials: This randomized controlled double blind clinical trial was done on 231 women with BMI > 30 who underwent elective cesarean section. Patients were randomly divided to intervention and control groups. Keflin 2 gr IV was administered 0.5 hr before surgery for both intervention and control groups. Cefalexin (placebo) every 6 hr and azythromycin (placebo) every 12 hr for control group and cephalexin 500 mg every 6 hr and azithromycin 250 mg every 12 hr for intervention group were administered for 48 hrs. Patients were under observation till 1 month after surgery. Fever, wound infection, endometritis and hospitalization were compared between two groups with SPSS v. 18. Results: A total of 231 patients 113 (48.9%) were enrolled in intervention group and 118 (51.1%) in control group with mean age of (28.53 ± 5.51) recruited. BMI distribution did not differ in the two groups. Hospitalization in control group was significantly higher than that in intervention group (2.58 ± 0.99) vs (2.11 ± 0.45) (P value < 0.001). BMI in intervention group with and without fever was (34.62 ± 2.64) and (30.89 ± 2.80), respectively (P value < 0.001). In control group, BMI in patients with and without fever was (38.60 ± 2.80) and (31.29 ± 1.28), respectively (P value = 0.001). Fever and endometritis simultaneously was seen in 3 (2.7%) of intervention group and 8 (6.8%) of control group. In interventions 3 (2.7%) had fever but no endometritis and 2 (1.8%) had endometritis but no fever (P < 0.001). In control group, 23 (19.5%) patients had fever but no endometritis and 4 (3.4%) patients had endometritis but no fever (P value < 0.001). Febrile patients in control group 31 (26.3%) were significantly more than those in intervention group 6 (5.3%) (P value < 0.001). Discussion: Administration of prophylactic azithromycin and cephalexin resulted in a decrease in febrile morbidity and length of hospital stay and is recommended. BMI of patients with fever was significantly higher in both intervention and control groups compared to those who didn’t experience fever. Postcesarean endometritis wasn’t significantly different in two groups. Postcesarean wound infection wasn’t seen in any group.

Cesarean Section and Prophylactic Antibiotics

Infectious morbidity remains a leading cause of postoperative complications following caesarean delivery. The major infectious complications of caesarean delivery are fever, wound infection, endometritis and urinary tract infection. Postoperative surgical site infection remains a major source of illness and a less frequent cause of death in the surgical patient. The administration of prophylactic antibiotics with in specific interval has been shown to reduce the burden of surgical site infection, but adherence to proper timing guidelines remains problematic. Judicious use of antibiotics in the hospital through effective antibiotic policy and guideline development is then essential. Pathogenesis of post-cesarean infection: Postoperative endometritis is a polymicrobial infection caused by bacteria normally present in the hosts lower genital tract. The major microorganisms responsible for endometritis are aerobic gram-negative bacilli, principally E.coli; anaerobic gram-negative bacilli, principally Bacteroides species and gardnerella vaginalis; aerobic gram-positive cocci, primarily Group B and Group D streptococci; and anaerobic gram- positive cocci, specifically peptococcus species and peptostreptococcus species. 5

38: Perinatal pharmacokinetics of azithromycin for cesarean prophylaxis

Extended spectrum cesarean prophylaxis at cord clamp with cefazolin and azithromycin (AZI), which covers Ureaplasma spp, decreases post-cesarean infections. A clinical trial is underway to determine if addition of AZI to cefazolin prior to incision reduces surgical site infections. This study sought to evaluate the perinatal pharmacokinetics of AZI following a single pre-incision dose.

EFFECT OF PLACENTAL REMOVAL METHOD ON THE DURATION OF SURGERY AND PUERPERAL INFECTION AFTER CESAREAN DELIVERY

We aimed to determine the effect of manual removal and spontaneous delivery of placenta on operative time and post cesarean infection . It was a prospective study on 2 62 women with normal and term pregnancy . Those were selected for electiv e cesarean section in Razi and I mam khomeini hospitals in Ahvaz Jundishapur University of medical sciences . The subjects were select by simple random sampling in two groups based on th e method of pla cental removal: study group (manual p lacental removal were 131) and control group ( spontaneous placental removal were 131) . Post cesarean endometritis was determined by at l e a st two temperature > 38/50 6 h apart after the first 24 h . Till 10 days offer cesarean section and uterin e tenderness or foul - smelling lochia . Operative time was recorded from the initial skin incision to the completion of skin closure. There was no significant difference in incidence of post cesarean infe ction between two groups. ( Study group % 11/4 and control group % 9/9 p > 0.05 ). The mean time of interval between newborn birth and placental removal in spontaneous delivery was 4 1/2 min ute as compare with manual removal group that was 1 1/1 min ute (p < 0.001) . However this span was more in study group there were no significant difference in total operating time between the two groups. The finding of our study s uggest s that, there is not an association between the method of pl a centa l d elivery and post cesarean infection in elective cesarean section.

Incidence of Post-Cesarean Uterine Infection in relation to Methods of Placental Management

Objectives: To study the rate of uterine infection following cesarean delivery with respect to mode of placental delivery and the practice of removal of residual membranes. Material and Methods: In 318 women undergoing elective cesarean delivery grouped based on placental management into four groups, viz., those with manual removal with uterine wiping (n=102), manual removal without uterine wiping (n=65), spontaneous extraction with uterine wiping (n=79), and spontaneous extraction without uterine wiping (n=72; taken as control group)were prospectively studied. The cases were monitored for 7 post-cesarean days for evidence of uterine infection. Uterine infection was considered to be present if at least two of the parameters with one of them being laboratory evidence, were positive. Results: Incidence of uterine infection was (65/ 318 cases, 20.4%).Occurrence of uterine infection did not differ when placenta was managed either manually or not (p=1). Uterine infection was apparently higher when residual membranes were not removed after placental delivery (p=0.4). Proportion of cases with uterine infection appeared to be lower in the group who had manual placental delivery and removal of residual membranes (17.7%) than in manual manual placental removal with no uterine wiping groups (24.6%). And there was no influence of post-placental removal of residual membranes in the cohort with unaided placental delivery (p=0.854). Conclusion: The practices of either manual removal of placenta or uterine wiping to clear the residual placental membranes do not increase the rate of post cesarean uterine infection rate after elective surgeries.

Risk factors for wound disruption following cesarean delivery

Objective: Risk factors for post-cesarean wound infection, but not disruption, are well-described in the literature. The primary objective of this study was to identify risk factors for non-infectious post-cesarean wound disruption.Methods: Secondary analysis was conducted using data from a single-center randomized controlled trial of staple versus suture skin closure in women ≥24 weeks’ gestation undergoing cesarean delivery. Wound disruption was defined as subcutaneous skin or fascial dehiscence excluding primary wound infections. Composite wound morbidity (disruption or infection) was examined as a secondary outcome. Patient demographics, medical co-morbidities, and intrapartum characteristics were evaluated as potential risk factors using multivariable logistic regression.Results: Of the 398 randomized patients, 340, including 26 with disruptions (7.6%) met inclusion criteria and were analyzed. After multivariable adjustments, African-American race (aOR 3.9, 95% CI 1.1–13.8) and staple – as opposed to suture – wound closure (aOR 5.4, 95% CI 1.8–16.1) remained significant risk factors for disruption; non-significant increases were observed for body mass index ≥30 (aOR 2.1, 95% CI 0.6–7.5), but not for diabetes mellitus (aOR 0.9, 95% CI 0.3–2.9). Results for composite wound morbidity were similar.Conclusions: Skin closure with staples, African-American race, and considering the relatively small sample size, potentially obesity are associated with increased risk of non-infectious post-cesarean wound disruption.