Comparison of the Effect of Administration Time of Prophylactic Antibiotics on Post-Operative Wound Infection after Caesarean Section

  • Maryam Mushtaq
  • Humaira Rizwan
  • Shermeen Kousar
  • Ayesha Akram HITEC-IMS Taxila
  • Samina Irshad
  • Nasim Irshad
Keywords: Cesarean delivery, Ceftriaxone, Wound infection

Abstract

Objective: To compare the post-operative wound infection rate after cesarean section in women receiving prophylactic antibiotics before skin incision with women receiving antibiotic after cord clamping of baby.

Study design: Randomized controlled trial

Place and Duration of Study:  Department of Obstetrics and Gynecology, Holy Family hospital, Rawalpindi from October 2017 to April 2018.

Materials & Methods: 356 patients pregnant female of age 20-45 years who were at term undergoing elective cesarean section for any indication were enrolled. All the patients were randomly divided into two groups. Group A (study group) was comprised of patients who received prophylactic antibiotic dose 15-60 min before the start of surgery. Group B (control group) was comprised of patients who received the antibiotic after the cord clamping of the baby.  The wound infection was noted for both the groups. All the patients were followed up for 8 days to assess infection. Data was analyzed using SPSS version 22. 

Results: Mean maternal age of the total study population found to be 28.6±5.3 years. Mean gestational age in all the enrolled patients found to be 37.7±1.2 weeks. Wound infection was noted in 28.4% (n=101) of total study population. Out of 101 total patients who presented with wound infection, 63 patients (62.4%) were of control group while only 38 (37.6%) patients belonged to study group. The difference was statistically significant (P<0.05).

Conclusions: Prophylactic antibiotic are useful for controlling post cesarean wound infection.

KEY WORDS: Cesarean delivery, Ceftriaxone, Wound infection

References

1. Rabinerson D, Ashwal E, Gabbay-Benziv R. Cesarean section through history. Harefuah. 2014;153(11):667-70.
2. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112:489-95.
3. Shrestha S, Shrestha R, Shrestha B, Dongol A. Incidence and risk factors of surgical site infection following cesarean section at Dhulikhel Hospital. Kathmandu Univ Med J (KUMJ). 2014;12(46):113-6.
4. Weinstein RA, Boyer KM. Antibiotic Prophylaxis for Cesarean Delivery - When Broader Is Better. N Engl J Med. 2016;375(13):1284-6.
5. Skjeldestad FE, Bjornholt JV, Gran JM, Erisken HM. The effect of antibiotic prophylaxis guidelines on surgical-site infections associated with cesarean delivery. Int J Gynaecol Obstet. 2015;128(2):126-30.
6. Westen EH, Kolk PR, van Velzen CL, Unkels R, Mmuni NS, Hamisi AD, et al. Single-dose compared with multiple day antibiotic prophylaxis for cesarean section in low-resource settings, a randomized controlled, noninferiority trial. Acta Obstet Gynecol Scand. 2015;94(1):43-9.
7. Lamont RF, Joergensen JS. Prophylactic antibiotics for caesarean section administered preoperatively rather than post cord clamping significantly reduces the rate of endometritis. Evid Based Med. 2014;19(1):17.
8. Francis C, Mumford M, Strand ML, Moore ES, Strand EA. Timing of prophylactic antibiotic at cesarean section: a double-blinded, randomized trial. J Perinatol. 2013;33(10):759-62.
9. Dlamini LD, Sekikubo M, Tumukunde J, Kojjo C, Ocen D, Wabule A, et al. 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. BMC Pregnancy Childbirth. 2015;15:91.
10. Leth RA, Møller JK, Thomsen RW. Risk of selected postpartum infections after cesarean section compared with vaginal birth: a five-year cohort study of 32,468 women. Acta Obstet Gynecol Scand. 2009;88:976–83.
11. Conroy K, Koenig AF, Yu YH, Courtney A, Lee HJ, Norwitz ER. Infectious morbidity after cesarean delivery: 10 strategies to reduce risk. Rev Obstet Gynecol. 2012;5:69-77.
12. Petter, CE, Franco Farret, TC, de Souza Scherer, J, Antonello, VS. Fatores relacionados a infecções de sítio cirúrgico após procedimentos obstétricos. Sci Med. 2013;23:28–33.
13. Baaqeel, H, Baaqeel, R. Timing of administration of prophylactic antibiotics for caesarean section: a systematic review and meta-analysis. Br J Obstet Gynaecol. 2013;120:661–9.
14. Srun, S, Sinath, Y, Seng, AT. Surveillance of post-caesarean surgical site infections in a hospital with limited resources, Cambodia. J Infect Dev Ctries. 2013;7:579–85.
15. Ledger WJ. Current problems in antibiotic treatment in obstetrics and gynecology. Rev Infect Dis. 1985;7:S679-89.
16. Kunz J, Lüthy R. Recommendations for the systemic perioperative prevention of infections in gynecology and obstetrics. Schweiz Med Wochenschr. 1984;114:956-60.
17. ACOG practice bulletin number 47, October 2003: Prophylactic Antibiotics in Labor and Delivery. Obstet Gynecol. 2003;102:875–82.
18. Chelmow D, Ruehli MS, Huang E. Prophylactic use of antibiotics for nonlaboring patients undergoing cesarean delivery with intact membranes: a meta-analysis. Am J Obstet Gynecol. 2001;184:656–61.
19. Bailey SR, Field N, Townsend CL, Rodger AJ, Brocklehurst P. Antibiotic prophylaxis for women undergoing caesarean section and infant health. Br J Obstet Gynaecol. 2016;123:875–6.
20. NICE. Caesarean section: full guideline. NICE clinical guideline 132. London: NICE; 2011
21. Dinsmoor MJ, Gilbert S, Landon MB, Rouse DJ, Spong CY, Varner MW, et al. Perioperative antibiotic prophylaxis for nonlaboring cesarean delivery. Obstet Gynecol. 2009;114:752–6.
22. Lamb HM, Ormrod D, Scott LJ, Figgitt DP. Ceftriaxone: an update of its use in the management of community-acquired and nosocomial infections. Drugs. 2002;62(7):1041-89.
23. Kumari R, Sharma A, Sheetal, Roy P, Anupriya. To study the effectiveness of prophylactic use of ceftriaxone (single dose) in caesarean section in low risk patients in a tertiary care center, Moradabad, India. Int J Res Med Sci. 2017;5:5278-82..
24. Mackeen AD, Packard RE, Ota E, Berghella V, Baxter JK. Timing of intravenous prophylactic antibiotics for preventing postpartum infectious morbidity in women undergoing cesarean delivery. Cochrane Database Syst Rev. 2014;1:CD009516.
25. Khlifi A, Kouira M, Bannour I, Hachani F, Kehila M, Ferhi F, et al. What's the optimal time of cesarean section antibiotic prophylaxis, before skin incision or after umbilical cord clamping? A prospective randomized study. J Gynecol Obstet Biol Reprod (Paris). 2016;45:1133-43.
Published
2021-06-30
How to Cite
1.
Mushtaq M, Rizwan H, Kousar S, Akram A, Irshad S, Irshad N. Comparison of the Effect of Administration Time of Prophylactic Antibiotics on Post-Operative Wound Infection after Caesarean Section. JRMC [Internet]. 30Jun.2021 [cited 4Dec.2021];25(2):251-7. Available from: http://www.journalrmc.com/index.php/JRMC/article/view/1596
Section
Articles

Most read articles by the same author(s)