Prophylaxis In Cesarean Section Research Articles

Antibiotic prophylaxis for caesarean section at a Ugandan hospital: a randomised clinical trial evaluating the effect of administration time on the incidence of postoperative infections.

BackgroundProphylactic antibiotics are used to prevent postoperative infections after caesarean section. Studies have suggested that the timing of prophylaxis plays an important role. Over the years, the role of the anaesthesiologist in the administration of prophylactic antibiotics has become prominent. Therefore, there is an increasing need for anaesthesia providers to understand the rationale of antibiotic prophylaxis. We therefore sought to compare the effect of antibiotics prophylaxis within 1 hour before skin incision and after skin incision on the incidence of postoperative infections in patients undergoing caesarean section at Mulago Hospital.MethodsWe conducted a single-blind randomised clinical trial conducted at Mulago Hospital evaluating 464 patients undergoing emergency caesarean section. Patients were randomly assigned a group number that allocated them to either arm of the study. They received the same prophylactic antibiotic according to their allotment, that is, either within 1 hour before skin incision or after skin incision as per current standards of practice in Mulago Hospital. They were followed up to detect infection up to 10 days postoperatively. The primary outcome was postoperative infection. The data collected were analysed with STATA version 12 using univariate and bivariate analysis.ResultsThe risk of overall postoperative infection was significantly lower when prophylaxis was given within an hour before incision (RR O.77, 95% CI 0.62–0.97). We also found endometritis to be significantly reduced in the pre-incision group (RR 0.62; 95% CI 0.39–0.99; P value 0.036).ConclusionsGiving prophylactic antibiotics before skin incision reduces risk of postoperative infection, in particular of endometritis.Trial registrationPan African Clinical Trial Registry PACTR201311000610495.Date of trial registration: 12th August 2013.

Antibiotic prophylaxis in cesarean section and other surgical procedures: a Korean national assessment system

Prophylactic antibiotic management is a major issue in surgical patients, as the postoperative risk of infection is very high, especially in vulnerable populations. Westen et al. reported that a single dose of prophylactic ampicillin and metronidazole is as effective as a multiple-day regimen of these antibiotics, which would allow a significant dose reduction while decreasing healthcare costs 1. Between 2005 and 2006, the Korean Ministry of Health and Welfare began assessment of antibiotic prescriptions for surgical patients. In 2007 it extended the assessment program to include antibiotic prophylaxis in patients undergoing hysterectomy and cesarean section 2. Since then, prophylactic antibiotic monitoring has been extended annually and now includes gastric, heart, knee, thyroid, and breast operations, as well as neurosurgery, and more. As of 2014, 15 types of surgery were covered by the assessment program 2. Among the 12 parameters evaluated in the program are prophylactic antibiotics administration one hour before the first indication, dose of antibiotics, rates of aminoglycoside administration, rates of third-generation cephalosporin administration, rates of co-administered prophylactic antibiotics, antibiotic prescription rates at discharge, total average number of days of prophylactic antibiotic administration, and history of antibiotic allergy 2. The exclusion criteria are based on clinical symptoms and diagnosis. Thus, patients with three days of high fever postoperatively, infection, transfusion of >4 units of blood within 24 h postoperatively, drainage of an abscess at the surgical site, pneumonia, sepsis, and/or disruption of the surgical wound or other evidence of serious infection are excluded from the assessment. Based on the results, hospitals are ranked in five levels, which are reported annually on the website of the Korean Ministry of Health and Welfare and in Korean newspapers. Korea has a national insurance system that contributes to the cost of surgical procedures. In 2014, the government started a hospital incentive system based on the above-mentioned rankings. Thus, the government pays more to high-ranking and less to low-ranking hospitals. In 2014, 11 hospitals qualified for the incentive program 2. In view of the legal problems that confront surgeons whose patients experience postoperative infectious complications, a surgeon cannot initiate a reduction in prophylactic antibiotics. The primary goal of the assessment is to reduce antibiotic abuse and medical costs while improving the quality of surgical care. According to a health insurance review, in 2009, total antibiotics use per operation had decreased by 36.4% compared with 2006 2. The program to reduce prophylactic antibiotic use in surgical patients was initiated by the government health system, not by surgeons. However, the Korean data have made an important contribution to surgical practice and to the development of government health insurance policies.

Crystalloid preload shows transient superiority over colloid, or their combination in spinal anaesthesia - induced hypotension prophylaxis for caesarean section

Many studies comparing different intravenous fluid types usually do not use equipotent volumes of 3:1 crystalloid: colloid ratio in such comparisons. Conflicting results emanate from such studies. This study was designed to compare the efficacy of equipotent volumes of crystalloid, colloid and combination of crystalloid/colloid in spinal anaesthesia-induced hypotension prophylaxis. Pregnant women scheduled for elective Caesarean section were prospectively randomized to three groups to each received either 1 500 ml of Ringers lactate, or 500 ml of 6% pentastarch or a combination of 250 ml of 6% pentastarch and 750 ml of Ringers lactate intravenous fluid preload, before spinal anaesthesia. Hemodynamic variables were monitored. First 10 minutes, crystalloid showed better efficacy in hypotension prophylaxis over the other regimen. In the next 30 minutes however, there were no significant differences between the groups. Crystalloids proved more effective than colloid or their combination in hypotension prophylaxis in the first 10 minutes after spinal anaesthesia.

Maternal and institutional characteristics associated with the administration of prophylactic antibiotics for caesarean section: a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health

To illustrate the variability in the use of antibiotic prophylaxis for caesarean section, and its effect on the prevention of postoperative infections. Secondary analysis of a cross-sectional study. Twenty-nine countries participating in the World Health Organization Multicountry Survey on Maternal and Newborn Health. Three hundred and fifty-nine health facilities with the capacity to perform caesarean section. Descriptive analysis and effect estimates using multilevel logistic regression. Coverage of antibiotic prophylaxis for caesarean section. A total of 89 121 caesarean sections were performed in 332 of the 359 facilities included in the survey; 87% under prophylactic antibiotic coverage. Thirty five facilities provided 0-49% coverage and 77 facilities provided 50-89% coverage. Institutional coverage of prophylactic antibiotics varied greatly within most countries, and was related to guideline use and the practice of clinical audits, but not to the size, location of the institution or development index of the country. Mothers with complications, such as HIV infection, anaemia, or pre-eclampsia/eclampsia, were more likely to receive antibiotic prophylaxis. At the same time, mothers undergoing caesarean birth prior to labour and those with indication for scheduled deliveries were also more likely to receive antibiotic prophylaxis, despite their lower risk of infection, compared with mothers undergoing emergency caesarean section. Coverage of antibiotic prophylaxis for caesarean birth may be related to the perception of the importance of guidelines and clinical audits in the facility. There may also be a tendency to use antibiotics when caesarean section has been scheduled and antibiotic prophylaxis is already included in the routine clinical protocol. This study may act as a signal to re-evaluate institutional practices as a way to identify areas where improvement is possible.

Adecuación de la profilaxis antibiótica en el parto por cesárea

ObjectiveTo evaluate compliance with a protocol for antibiotic prophylaxis in cesarean sections and its influence on the incidence of surgical wound infection. Patients and methodsA prospective cohort study was carried out to assess compliance with our antibiotic prophylaxis protocol. Percentages of compliance and the cumulative incidence of infection were calculated. The effect of compliance with the protocol for antibiotic prophylaxis on surgical wound infection was estimated with the relative risk. ResultsWe included 680 patients. Overall compliance with the protocol was 95.7%. The most frequent cause of lack of compliance was the time of administration (96.6%). The cumulative incidence of infection was 2.5% and there was no association between compliance with the protocol and the infection rate (RR=4.5; 95% CI: 0.55-38.4; P>.05). ConclusionsCompliance with the protocol for antibiotic prophylaxis was high. The cumulative incidence of surgical wound infection was low and was unrelated to antibiotic prophylaxis.

Preoperative granisetron for shivering prophylaxis in cesarean section under spinal anesthesia

Background Shivering is one of the common problems during spinal anesthesia and may lead to several complications, interfere with patient monitoring, and is bothersome for the mother while holding her newborn. We performed this prospective, double-blinded, placebo-controlled study to determine the ability of preoperative intravenous (IV) granisetron to prevent or decrease shivering after spinal anesthesia during elective cesarean delivery. Materials and methods A total of 117 ASA I/II parturient women undergoing elective cesarean delivery were enrolled. Patients were randomly allocated into two groups: group G ( n = 58) received 3 mg in 3 ml granisetron intravenously and group P ( n = 59) received 3 ml intravenous normal saline before performing spinal anesthesia. Spinal anesthesia was performed in all patients using 10 mg heavy bupivacaine 0.5% and 15 μg fentanyl. Shivering was graded according to the Wrench score: 0 = no shivering; 1 = piloerection, peripheral vasoconstriction, or peripheral cyanosis without other cause; 2 = visible muscular activity confined to one muscle group; 3 = visible muscular activity in more than one muscle group; and 4 = gross muscular activity involving the entire body. Rescue medication intake, interference with neonatal holding, interference with monitoring, and maternal vomiting in 12 h postoperative as well as tympanic membrane temperature and Apgar score were recorded. Results The percentage of shivering and shivering score value among parturients in both groups did not show significant statistical difference during the study time periods, with a P value greater than 0.05. With respect to rescue medication intake ( P = 0.086) as well as interference with monitoring ( P = 0.653) and neonatal holding ( P = 0.653), there was no statistically significant difference as well. In addition, tympanic membrane temperature ( P = 0.48) and 1-min Apgar score ( P = 0.09) did not show statistically significant difference. Granisetron significantly reduced the incidence of nausea and vomiting during the 12-h postoperative period, with only six (10.3%) mothers in group G complaining of nausea and vomiting in comparison with 16 (27.1%) mothers in group P ( P = 0.036). Conclusion Preoperative intravenous granisetron for shivering prophylaxis in cesarean section under spinal anesthesia did not significantly reduce the incidence or severity of shivering.

Antibioprophylaxie pour césarienne : modification des pratiques et administration avant incision, enquête de faisabilité auprès des pédiatres du réseau de santé périnatale d’Auvergne (RSPA)

ObjectiveTo describe the knowledge of paediatricians regarding the practice of antimicrobial prophylaxis for caesarean section in reference to the Consensus Conference of the French Society of Anesthesia and Intensive Care (SFAR) and assess the feasibility of a change in attitude (injection of the antibiotic prior to incision) among paediatricians Perinatal Health Network of Auvergne (RSPA) working in maternity. Study designCross sectional study by survey. MethodsFirst questionnaire was sent to 46 RSPA paediatricians working in maternity. Almost one-third of paediatricians who returned the questionnaire said they were not concerned. A second questionnaire was developed with two paediatricians of the CHU and sent to the same 46 paediatricians. The statistical part involved percentages. ResultsResponse rates were respectively 61% and 67%. For the first questionnaire, only 25% of the paediatricians knew the antibiotic and the time for injection. For the second questionnaire, 87% were in favour of an administration before incision and 42% thought it will not affect the care of the newborn. For 35% of respondents, it could lead to a change in the duration of antibiotic therapy in cases of perinatal infection and for 13% only a delay in the implementation of antibiotic therapy in children. ConclusionThe RSPA paediatricians did not know the practices of antibiotic prophylaxis for caesarean section. However, they did not appear opposed to an administration before cord clamping as it would not delay the implementation of any antibiotics in the newborn.

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

Antibiotic prophylaxis for caesarean section: exchanging one risk for another?

Antibiotic prophylaxis for caesarean section: exchanging one risk for another?

Perioperative Temporary Occlusion of the Internal Iliac Arteries as Prophylaxis in Cesarean Section at Risk of Hemorrhage in Placenta Accreta

The purpose of this study was to describe the preliminary results of prophylactic temporary balloon occlusion of the internal iliac arteries for bleeding control in patients with placenta accreta during cesarean hysterectomy. From May 2006 to March 2010, 21 patients diagnosed with placenta accreta using ultrasound and/or magnetic resonance imaging were submitted to prophylactic balloon occlusion before hysterectomy. Fluoroscopy, balloon occlusion time, surgical duration, intraoperative blood loss, transfusion volume, and procedure complications were analyzed. The mean age was 30.5 years with a mean of 3.6 previous gestations. Imaging studies revealed that all patients had placenta accreta and all were submitted to cesarean hysterectomy. One hysterectomy was due to previous diagnosis of fetal death and another due to cesarean with uterine curettage. Mean fluoroscopy time was 7.5 min, balloon occlusion time was 164 min, and surgery duration was 260 min. Estimated blood loss was 1,671.5 ml with mean reposition fluids of 3,538 ml of crystalloids, 309.5 ml of colloids, and 1.24 ml of packed red blood cells. Two patients were submitted to thromboembolectomy due to prolonged surgical time. There was no maternal or fetal mortality related to the procedure. The results demonstrated that prophylactic balloon occlusion of internal iliac artery is a safe method and appears to reduce blood loss and transfusion requirements in patients diagnosed with placenta accreta who undergo cesarean hysterectomy. Antenatal imaging diagnosis of placenta accreta enables preoperative planning.

Antibiotikaprofylakse ved keisersnitt - retningslinjer ved norske fødeavdelinger

The frequency of caesarean sections is increasing. Infection in operation wounds and/or underlying spaces and organs is a common complication. In Veileder I fødselshjelp [Clinical Guidelines in Obstetrics], 2008, antibiotic prophylaxis is recommended in the form of single dose ampicillin or first generation cephalosporins in connection with acute caesarean sections and under special conditions such as prolonged operations. We wanted to find out whether Norwegian maternity departments follow these recommendations. All head senior consultants at maternity departments that carried out more than one caesarean section in 2008 were invited to take part in a survey of the department's written guidelines for use of antibiotic prophylaxis in connection with caesarean section. The extent to which the guidelines were followed was evaluated using data from the Norwegian Surveillance System for Hospital-Associated Infections (NOIS). 38 of the 42 maternity wards in the investigation had written guidelines for antibiotic prophylaxis. Four of these maternity wards gave prophylaxis in all Caesarean sections, one only on indication, and 33 in acute Caesarean section. The guidelines varied as regards choice of type of antibiotic and time of administration. In the maternity wards with written guidelines recommending use of antibiotic prophylaxis in all Caesarean sections, were practice in accordance with the guidelines. When the guidelines recommended prophylactic use only in acute operations, there was agreement between practice and guidelines in 71 % to 97 % of the patients in the ward. Most Norwegian maternity wards have written guidelines on antibiotic prophylaxis in Caesarean section. The contents of the guidelines varied but are mainly in agreement with current Norwegian recommendations.

Current debate on the use of antibiotic prophylaxis for caesarean section.

Caesarean delivery is frequently complicated by surgical site infections, endometritis and urinary tract infection. Most surgical site infections occur after discharge from the hospital, and are increasingly being used as performance indicators. Worldwide, the rate of caesarean delivery is increasing. Evidence-based guidelines recommended the use of prophylactic antibiotics before surgical incision. An exception is made for caesarean delivery, where narrow-range antibiotics are administered after umbilical cord clamping because of putative neonatal benefit. However, recent evidence supports the use of pre-incision, broad-spectrum antibiotics, which result in a lower rate of maternal morbidity with no disadvantage to the neonate.

Are local clinical guidelines useful in promoting rational use of antibiotic prophylaxis in Caesarean delivery?

To identify changes in prescribing patterns of antibiotic prophylaxis in caesarean delivery after introduction of local clinical guidelines. To identify changes in outcomes of prescribing antibiotics following the implementation of local clinical guidelines on antibiotic prophylaxis. University of Belgrade, Medical School, Clinic of Gynaecology and Obstetrics "Narodni front" Belgrade, Serbia. A quantitative retrospective analysis of antibiotic use before (January-June 2005), and following (January-June 2006) implementation of guidelines on antibiotic prophylaxis in two wards. Patients who underwent caesarean section prior to (261) and following (281) introduction of local guidelines, participated in this study. Drug utilization cost presented as the number of DDD/100 bed days/eur, the average duration of hospital stay, number of wound infections. There was a significant change in prescribing patterns of antibiotic prophylaxis in caesarean section following introduction of local guidelines. The use of ceftriaxone, amikacin and metronidazole decreased (57.47% vs. 11.74%; 9.19% vs. 4.27%; 61.69% vs. 46.26%, respectively). On the other hand, the use of "older" antibiotics such as gentamicin, cefuroxime, cefazolin and ampicillin increased (14.56% vs. 29.18%; 9.2% vs. 17.44%; 9.58% vs. 45.2% and 0% vs. 3.9%, respectively). DDD/100 bed days/eur analysis revealed a 47% decrease of total cost for prophylactic antibiotic treatment in caesarean section following local guideline implementation. In contrast, rate of wound infections and duration of hospital stay were not significantly different in both groups. In an attempt to ensure cost-effective prophylactic use of antibiotics in caesarean delivery, local clinical guidelines were introduced. They resulted in changes in prescribing patterns of antibiotics. There was a significant decrease in use of 'third' generation of cephalosporin's whereas the use of "older" antibiotics with proven efficacy and safety increased. In contrast, there was no significant change in treatment outcomes such as wound infection and average hospital stay.

Antibioprophylaxie pour césarienne avant incision ou après clampage du cordon ? Méta-analyse

Objective The objective of this systematic review was to assess the effect of preoperative rather than after umbilical cord clamping antimicrobial prophylaxis for caesarean delivery on maternal and neonatal infectious postoperative morbidity. Study design Meta-analysis. Methods Three electronic databases (Pubmed, Cochrane Central Register of Randomized Controlled Trials and Embase) were searched without language restriction and retrieved 201 potentially relevant trials. Five randomized controlled trials ( n = 1108) studying the timing of antimicrobial prophylaxis for caesarean section were included. The quality of included trials was assessed on the modified Oxford validity scale. Results Preoperative administration of antibiotics ( n = 456) rather than after cord clamping ( n = 563) provides a significant reduction in the incidence of endometritis (Odds Ratio (OR) 0.59 [95% Confidence Interval (CI) 0.35–0.98]) and of total maternal infectious morbidity (OR 0.51 [95% CI 0.32–0.82]). This benefit was not observed regarding the incidence of wound infection (Peto OR 0.58 [95% CI 0.29–1.16]), neonatal infection (Peto OR 1.06 [95% CI 0.57–1.96]), neonatal sepsis workup (OR 1.02 [95% CI 0.67–1.54]), neonatal documented sepsis (Peto OR 0.93 [95% CI 0.43–2.02]) or neonatal intensive care unit admission (OR 0.97 [95% CI 0.61–1.56]). No significant heterogeneity was observed between the included studies. Conclusion This meta-analysis provides strong evidence that the preoperative rather than after cord clamping administration of antimicrobial prophylaxis for caesarean delivery provides a reduction in the incidence of endometritis and maternal total infectious morbidity without affecting the incidence of wound infection and neonatal infectious morbidity.

Audit and feedback: Effects on professional obstetrical practice and healthcare outcomes in a university hospital

To assess the effects of audit and feedback on the practice of professionals in obstetrics. Before-after intervention study. Obstetric unit of a university hospital in Brazil. Before the intervention the prevalence rates of six evidence-based interventions were assessed. Seminars and workshops were administered, with the baseline results and also the main contents from systematic reviews on the topics studied, followed by detailed discussion of each topic, based on the Reproductive Health Library. After four months, the same practices were measured again and compared with the pre-intervention period. Selective episiotomy; continuous electronic fetal monitoring (EFM) during labor of low-risk pregnant women; antibiotic prophylaxis in cesarean section; active management of third stage of labor; routine induction of labor at 41 weeks for uncomplicated pregnancies; and continuous support for women during childbirth. Both periods showed a similar number and mode of deliveries. There was a significant reduction in episiotomies (RR = 0.84; 0.73-0.97) and an increase in continuous support for women during childbirth by a companion (RR = 1.42; 1.24-1.63). Although there was not a significant change in the use of oxytocin during the third stage of labor, there was a shift to the internationally recommended dosage of 10 IU (p<0.0001). There was no significant change in the use of antibiotic prophylaxis for cesarean section, continuous EFM, or routine induction of labor at 41 weeks for uncomplicated pregnancies. Audit and feedback can be used as a tool to improve obstetrical practice, at least for some interventions and when the medical staff is open and receptive to change.

Preoperative Antibiotic Prophylaxis for Cesarean Delivery Preferred

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.

Short term antibiotic prophylaxis for emergency cesarean delivery : Is there a difference?

Objective : To evaluate the efficacy of amoxicillin-clavulanic acid when given as a two dose versus the more traditional triple dose regimen for cesarean section prophylaxis. Methods : We conducted a prospective study of 122 women undergoing emergency cesarean section. All patients received 2.4 g of amoxicillin-clavulanic acid at the time of cord clamping intravenously. Subsequent doses of 1.2 g were administered 6 hours apart after the initial dose. Results : Patient characteristics and risk factors for infection were comparable for the two groups. Analysis of results demonstrated no significant differences in infective morbidity (6.5% versus 8.1%) between the two and triple dose groups respectively. Conclusion : The results of the present study suggest that two doses of amoxicillin-clavulanic acid is equally effective as triple dose therapy in reducing post cesarean section endometritis. This implies that two dose regimen would decrease the cost to the patient while maintaining very acceptable infection rates.

Use of Evidence-Based Practices in Pregnancy and Childbirth: South East Asia Optimising Reproductive and Child Health in Developing Countries Project

BackgroundThe burden of mortality and morbidity related to pregnancy and childbirth remains concentrated in developing countries. SEA-ORCHID (South East Asia Optimising Reproductive and Child Health In Developing countries) is evaluating whether a multifaceted intervention to strengthen capacity for research synthesis, evidence-based care and knowledge implementation improves adoption of best clinical practice recommendations leading to better health for mothers and babies. In this study we assessed current practices in perinatal health care in four South East Asian countries and determined whether they were aligned with best practice recommendations.Methodology/Principal FindingsWe completed an audit of 9550 medical records of women and their 9665 infants at nine hospitals; two in each of Indonesia, Malaysia and The Philippines, and three in Thailand between January-December 2005. We compared actual clinical practices with best practice recommendations selected from the Cochrane Library and the World Health Organization Reproductive Health Library.Evidence-based components of the active management of the third stage of labour and appropriately treating eclampsia with magnesium sulphate were universally practiced in all hospitals. Appropriate antibiotic prophylaxis for caesarean section, a beneficial form of care, was practiced in less than 5% of cases in most hospitals. Use of the unnecessary practices of enema in labour ranged from 1% to 61% and rates of episiotomy for vaginal birth ranged from 31% to 95%. Other appropriate practices were commonly performed to varying degrees between countries and also between hospitals within the same country.Conclusions/SignificanceWhilst some perinatal health care practices audited were consistent with best available evidence, several were not. We conclude that recording of clinical practices should be an essential step to improve quality of care. Based on these findings, the SEA-ORCHID project team has been developing and implementing interventions aimed at increasing compliance with evidence-based clinical practice recommendations to improve perinatal practice in South East Asia.

Optimizing antibiotic usage in adults admitted with fever by a multifaceted intervention in an Indonesian governmental hospital

To optimize antimicrobial treatment of patients with fever upon admission to the department of internal medicine of Dr Soetomo Hospital in Surabaya, Indonesia. Prospective intervention study. The intervention comprised development of a consensus guideline, an official declaration of the guideline by the head of department, distributing a guideline pocketbook, carrying out blood cultures free of charge, teaching sessions and refresher courses. The outcome was measured with reference to (i) percentage of patients with fever started on antibiotic therapy, (ii) amount of antibiotics used expressed as defined daily doses (DDD)/100 patient-days, (iii) percentage of appropriate prescriptions and of prescriptions without indication as assessed by independent reviewers, (iv) percentage of treatments in accordance with guidelines, (v) percentage of patients in whom blood cultures were taken before starting antimicrobial therapy, (vi) percentage of treatments appropriately stopped on re-evaluation of the patients at 72 h and (vii) mortality. The study involved 501 patients, 95 residents and 60 specialists. After the intervention 17% patients less were treated with antibiotics upon admission and antibiotic use fell from 99.8 to 73 DDD/100 patient-days. The percentage of patients with sepsis and dengue treated in accordance with the guideline increased by 23% and 30%. The percentage of appropriate therapies, therapies without indication and mortality did not change significantly. The percentage of patients for whom a blood culture was taken upon admission increased from 3% to 81%; however, almost all were taken after they commenced antibiotic therapy. Therapy was not adjusted after 72 h in any case. Interrupted time series analysis showed that the start of development of the guideline and the declaration of the guideline were the interventions with the greatest impact. The multifaceted intervention had limited success. A very important drawback to the prudent use of antibiotics was the absence of adequate microbiological diagnostics.

Revisões sistemáticas de antibioticoprofilaxia em cesarianas

This study reviews the available evidence on the efficacy of antibiotic prophylaxis in cesarean sections. The study included a detailed analysis of the quality of design and performance and the clinical heterogeneity of selected clinical trials. Meta-analysis of placebo-controlled trials estimated an efficacy of some 65% for the two study endpoints, endometritis and surgical wound infection, corresponding to a decrease in infection rates of some 11% and 5%, respectively. Sensitivity analyses showed summary effects similar to those observed for all studies. Results for the non-elective cesarean sections subgroup (12 studies) indicated a relevant benefit for both endpoints, corresponding to a decrease in incidence rates of some 14% (endometritis) and 5% (surgical infection wound). For elective surgeries (two trials), no relevant benefit was found. Evidence from comparative trials on number of doses was limited due to important methodological shortcomings and to the small number of patients enrolled (three trials). Comparative drug trials (seven studies) did not show evidence of different performance between first and second-generation cephalosporins.