Timing of administration of prophylactic antibiotics for caesarean section: a systematic review and meta-analysis

College of Medicine-Jeddah, King Saud bin Abdulaziz University for Health Sciences and Department of OB/GYN, King Abdulaziz Medical City-WR, Jeddah, Saudi Arabia.
BJOG An International Journal of Obstetrics & Gynaecology (Impact Factor: 3.86). 11/2012; 120(6). DOI: 10.1111/1471-0528.12036
Source: PubMed

ABSTRACT BACKGROUND: Prophylactic antibiotics reduce infectious morbidity from caesarean section. The timing of their administration, however, is a matter of controversy. OBJECTIVES: To examine maternal and neonatal infectious morbidity in women receiving preoperative prophylaxis compared with those receiving intraoperative administration. SEARCH STRATEGY: Medline, Embase, Current Controlled Trials and Cochrane Central were searched from their inception dates to December 2011. SELECTION CRITERIA: Randomised controlled trials of a single dose of any antibiotic comparing preoperative with intraoperative administration were selected. DATA COLLECTION AND ANALYSIS: Trial characteristics, outcomes and quality measures, based on the Cochrane tool for risk of bias, were independently extracted. The random effect model of DerSimonian and Laird to estimate relative risks (RRs) for maternal and neonatal outcomes was used. MAIN RESULTS: Six trials met the inclusion criteria, reporting on 2313 women and 2345 newborns. Preoperative administration was associated with a significant 41% reduction in the rate of endometritis compared with intraoperative administration (RR 0.59; 95% confidence interval [95% CI] 0.37-0.94; I(2) 0%). In the preoperative group, there were nonsignificant reductions in the rates of wound infection (RR 0.71; 95% CI 0.44-1.14; I(2) 0%), maternal febrile morbidity (RR 0.94; 95% CI 0.46-1.95; I(2) 0%), neonatal sepsis (RR 0.81; 95% CI 0.47-1.41; I(2) 0%), neonatal septic work-up (RR 0.93; 95% CI 0.71-1.21; I(2) 0%) and neonatal intensive-care unit admission (RR 0.92; 95% CI 0.65-1.28; I(2) 0%). There were nonsignificant increases in the rates of maternal pyelonephritis (RR 1.09; 95% CI 0.49-2.43; I(2) 0%) and neonatal pneumonia (RR 3.36; 95% CI 0.55-20.47; I(2) 0%). CONCLUSIONS: Compared with intraoperative administration, preoperative antibiotics significantly reduce the rate of endometritis. The lack of neonatal adverse effects should be cautiously interpreted given the limited power of the trials to detect such effects.

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Available from: Hassan Said Ba'aqeel, Jun 22, 2015
  • Obstetric Anesthesia Digest 01/2014; 34(3):136-137. DOI:10.1097/01.aoa.0000452147.34903.17
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    ABSTRACT: Prophylactic 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. We 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. The 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). Giving prophylactic antibiotics before skin incision reduces risk of postoperative infection, in particular of endometritis. Pan African Clinical Trial Registry PACTR201311000610495. Date of trial registration: 12(th) August 2013.
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    ABSTRACT: Caesarean section in obese patients is associated with an increased risk of surgical wound complications, including haematoma, seroma, abscess and dehiscence. This review focusses on the available strategies to decrease wound complications in this population, and on the clinical management of these situations. Appropriate dose of prophylactic antibiotics, closure of the subcutaneous tissue, and avoidance of subcutaneous drains reduce the incidence of wound complications associated with caesarean section in obese patients. For treatment of superficial wound infection associated with dehiscence, there are data from general surgery patients to suggest that the use of vacuum-assisted devices leads to faster healing and that surgical reclosure is preferable to healing by secondary intention, when there are no signs of ongoing infection. There is a need for stronger evidence regarding the prevention and management of wound complications for caesarean section in obese women. Copyright © 2014 Elsevier Ltd. All rights reserved.
    Bailli&egrave re s Best Practice and Research in Clinical Obstetrics and Gynaecology 10/2014; 29(3). DOI:10.1016/j.bpobgyn.2014.08.009 · 3.00 Impact Factor

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