Different regimens of penicillin antibiotics given to women routinely for preventing infection after cesarean section

Liú, Dan; Zhang, Lingli; Zhang, Chuan; Chen, Min; Zhang, Li; Li, Jie; Liu, Guanjian

doi:10.1097/md.0000000000011889

Cited by 5 publications

(6 citation statements)

References 18 publications

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“…The several risk factors related to surgical site infections should be concerned. Due to the continuous liberalization of China’s second child policy, the maternal age is uneven, and the women with older age have relatively poor tolerance to surgery and immunity, which is an important risk factor for surgical site infection after cesarean section [ 26 ]. Besides, during the surgery, a large amount of bleeding may occur, which may cause anemia and even hemorrhagic shock [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

The risk factors and care measures of surgical site infection after cesarean section in China: a retrospective analysis

Cui

2021

BMC Surg

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Background Surgical site infections after cesarean section are very common clinically, it is necessary to evaluate the risk factors of surgical site infections after cesarean section, to provide evidences for the treatment and nursing care of cesarean section. Methods This study was a retrospective cohort study design. Patients undergone cesarean section in a tertiary hospital of China from May 2017 to May 2020 were identified, we collected the clinical data of the included patients, and we analyzed the infection rate, etiological characteristics and related risk factors of surgical site infection after caesarean section. Results A total of 206 patients with cesarean section were included, and the incidence of surgical site infection in patients with cesarean section was 23.30%. A total of 62 cases of pathogens were identified, Enterococcus faecalis (33.87%) and Escherichia coli (29.03%) were the most common pathogens. Both Enterococcus faecalis and Escherichia coli were highly sensitive to Cefoperazone, Meropenem, and Levofloxacin. Logistic regression analyses indicated that Age ≥ 30y (OR 4.18, 95%CI: 1.23–7.09), BMI ≥ 24 (OR 2.39, 95%CI: 1.02–4.55), duration of cesarean section ≥ 1.5 h (OR 3.90, 95%CI: 1.28–5.42), estimated blood loss ≥ 400 ml (OR 2.35, 95%CI: 1.10–4.37) and the duration of urinary catheter ≥ 24 h (OR 3.18, 95% CI: 1.21–5.71) were the independent risk factors of surgical site infection after cesarean section (all p < 0.05). Conclusions Age, BMI, duration of surgery, blood loss and urinary catheter use were associated with higher risk of the surgical site infection after cesarean section. Clinical preventions and interventions are warranted for those population to reduce the occurrence of surgical site infection.

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Section: Discussionmentioning

confidence: 99%

The risk factors and care measures of surgical site infection after cesarean section in China: a retrospective analysis

Cui

2021

BMC Surg

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“…Second, we did not perform subgroup analysis, since the positive results of this study did not show heterogeneity. In addition, we believe that subgroup analysis will not get positive results because recent studies comparing antibiotic use between intravenous injection and lavage groups, as well as before and after umbilical cord clamping and skin incision, have reported no significant differences between drug deliveries [ 9 , 22 , 23 ]. Another recent meta-analysis that investigated the use of cephalosporin generations and penicillin types to prevent maternal infection after cesarean delivery also did not find significant differences between these subgroups [ 6 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Although previous studies have suggested a similar efficacy across different antibiotic dosages [ 7 , 8 ], there is limited evidence regarding the comparison of the efficacy of different antibiotic classes and dosages. An existing review that used meta-analysis to analyze studies suggested that cephalosporins and penicillins may have similar efficacy in preventing maternal infection after cesarean delivery [ 6 , 7 , 9 ]. However, this systematic review was published several years ago; hence, an update may be required.…”

Section: Introductionmentioning

confidence: 99%

Is a single dose of commonly used antibiotics effective in preventing maternal infection after cesarean section? A network meta-analysis

et al. 2022

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Objective This study aimed to compare the efficacy of different antibiotic classes and dosages in preventing maternal infection after cesarean delivery. Methods Databases were searched for randomized controlled trials (RCTs) published between January 1980 and January 2021 on antibiotic use for the prevention of maternal infection after cesarean delivery. The outcomes were endometritis, febrile morbidity, and wound infection, reported as odds ratios (OR) and surface under the cumulative ranking curve analysis scores. Results A total of 31 RCTs met the inclusion criteria. In the network meta-analysis (NMA) for endometritis, pooled network OR values indicated that the following interventions were superior to placebo: cephalosporins (OR: 0.18, 95% credibility interval [CrI]: 0.07–0.45), penicillins (OR: 0.19, 95% CrI: 0.07–0.50), penicillins (multiple doses) (OR: 0.20, 95% CrI: 0.05–0.65), combination therapies (OR: 0.22, 95% CrI: 0.09–0.54), and cephalosporins (multiple doses) (OR: 0.25, 95% CrI: 0.08–0.74). In the NMA for febrile morbidity, placebo was more effective than the other interventions. In the NMA for wound infection, pooled network OR values indicated that the following interventions were superior to placebo: penicillin (OR: 0.14, 95% CrI: 0.05–0.37), cephalosporins (OR: 0.19, 95% CrI: 0.08–0.41), cephalosporins (multiple doses) (OR: 0.20, 95% CrI: 0.06–0.58), combination therapies (OR: 0.29, 95% CrI: 0.13–0.57), macrolides (OR: 0.33, 95% CrI: 0.15–0.74), and penicillins (multiple doses) (OR: 0.40, 95% CrI: 0.17–0.91). Conclusions Compared with placebo, a single dose of commonly used antibiotics may prevent maternal infection after cesarean delivery. However, the incidence of febrile morbidity was not reduced.

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“…Our low post‐caesarean superficial SSI rates might have been due to our anti‐infection practices at caesarean delivery comprising use of alcohol‐chlorhexidine solution for abdominal skin prep, 14 routine vaginal‐cervical cleansing with alcohol‐chlorhexidine solution, 15 prophylactic antibiotic administration prior to skin incision, 16 three doses of prophylactic broad spectrum intravenous antibiotics (cefuroxime and metronidazole), 17 delivery of placenta by cord traction, 18 subcutaneous and adipose tissue cleansing with alcohol‐chlorhexidine solution prior to skin closure 2 and exclusive use of subcuticular suture skin closure 19 . A recent publication from an urban public hospital in Penang, Malaysia of a retrospective chart review of 400 caesarean deliveries with completed data charts reported an SSI rate of 18.8% 20 …”

Section: Discussionmentioning

confidence: 99%

A randomised trial of caesarean wound coverage: exposed versus dressed

Tan

Rohani

Lim

et al. 2020

BJOG

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Objective To evaluate the superficial surgical site infection (SSI) rate to 28 days and patient satisfaction with wound coverage management when their transverse suprapubic caesarean wound is left exposed compared with dressed after skin closure. Design Randomised trial. Setting University Hospital, Malaysia: April 2016–October 2016. Population 331 women delivered by caesarean section. Method Participants were randomised to leaving their wound entirely exposed (n = 165) or dressed (n = 166) with a low adhesive dressing (next day removal). Main outcome measures Primary outcomes were superficial SSI rate (assessed by provider inspection up to hospital discharge and telephone questionnaires on days 14 and 28) and patient satisfaction with wound coverage management before hospital discharge. Results The superficial SSI rates were 2/153 (1.3%) versus 5/157 (3.2%) (relative risk [RR] 0.4, 95% CI 0.1–2.1; P = 0.45) and patient satisfaction with wound management was 7 [5–8] versus 7 [5–8] (P = 0.81) in exposed compared with dressed study groups, respectively. In the wound‐exposed patients, stated preference for wound exposure significantly increased from 35.5 to 57.5%, whereas in the wound‐dressed patients, the stated preference for a dressed wound fell from 48.5 to 34.4% when assessed at recruitment (pre‐randomisation) to day 28. There were no significant differences in inpatient additional dressing or gauze use for wound care, post‐hospital discharge self‐reported wound issues of infection, antibiotics, redness and inflammation, swollen, painful, and fluid leakage to day 28 across trial groups. Conclusion The trial is underpowered as SSI rates were lower than expected. Nevertheless, leaving caesarean wounds exposed does not appear to have detrimental effects, provided patient counselling to manage expectations is undertaken. Tweetable abstract An exposed compared with a dressed caesarean wound has a similar superficial surgical site infection rate, patient satisfaction and appearance.

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Different regimens of penicillin antibiotics given to women routinely for preventing infection after cesarean section

Cited by 5 publications

References 18 publications

The risk factors and care measures of surgical site infection after cesarean section in China: a retrospective analysis

The risk factors and care measures of surgical site infection after cesarean section in China: a retrospective analysis

Is a single dose of commonly used antibiotics effective in preventing maternal infection after cesarean section? A network meta-analysis

A randomised trial of caesarean wound coverage: exposed versus dressed

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