Effect of Post-cesarean Delivery Oral Cephalexin and Metronidazole on Surgical Site Infection Among Obese Women: A Randomized Clinical Trial

Valent, Amy M.; DeArmond, Chris; Houston, Judy M.; Reddy, Srinidhi; Masters, Heather R.; Gold, Alex; Boldt, Michael; DeFranco, Emily; Evans, Arthur T.; Warshak, Carri R.

doi:10.1097/01.aoa.0000542370.40319.d0

Cited by 5 publications

(6 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Various other available research compared the efficacy of painting with chlorhexidine versus povidone iodine 6 . Randomized controlled trials have evaluated the efficacy of various kinds 7,8 or doses 9 of systemic antibiotics in avoiding surgical‐site infection, but not the impact of preoperative skin antisepsis. Povidone iodine interacts with bacterial amino acids and fatty acids, destroying their cellular structures and enzymes, whereas chlorhexidine gluconate destroys bacterial cell membranes, causing leaking of cellular elements and coagulation of cell contents.…”

Section: Discussionmentioning

confidence: 99%

Skin preparation for prevention of surgical site infection after obstetrics and gynecological abdominal surgery: A quality improvement project

Singh

Gothwal

Pradhan

et al. 2021

J of Obstet and Gynaecol

View full text Add to dashboard Cite

Background One of the most common causes of postoperative morbidity is postoperative surgical site infection (SSI). Healthcare‐associated infection is a subject of great concern in healthcare services. The goal of the present study is to estimate the relative effectiveness of skin preparation solution chlorhexidine scrub followed by povidone‐iodine painting in the prevention of SSIs after caesarean delivery and abdominal gynecological surgery. Material and Methods This is a 1‐year randomized prospective research done at a tertiary care institution in western Rajasthan. Women who underwent caesarean and gynecological operations were randomly assigned to one of two groups. Enrolled patients were randomly assigned to have the surgical site painted with 10% povidone‐iodine or a chlorhexidine‐alcohol preparatory scrub followed by povidone‐iodine paint. According to the Centres for Disease Control and Prevention criteria, the outcomes were any SSI occurring within a week or during the 30‐day follow‐up period following the operation, including any superficial or deep SSI. Results A total of 251 patients were randomly assigned to two groups. Group A (povidone‐iodine paint) received 121 patients, whereas Group B (chlorhexidine scrub + povidone‐iodine paint) received 129 cases. The overall SSI rate in the present study was 8.76%. The SSI rate was lower in Group B (chlorhexidine scrub + povidone‐iodine paint) as compared to Group A (povidone‐iodine paint only) (5.4% vs. 12.4%; p = 0.04). Conclusion This study highlighted that chlorhexidine‐alcohol scrubbing followed by povidone‐iodine painting provides superior skin antisepsis in comparison to povidone‐iodine painting alone.

show abstract

Section: Discussionmentioning

confidence: 99%

Skin preparation for prevention of surgical site infection after obstetrics and gynecological abdominal surgery: A quality improvement project

Singh

Gothwal

Pradhan

et al. 2021

J of Obstet and Gynaecol

View full text Add to dashboard Cite

show abstract

“…As with any composite outcome, there is potential to mix outcomes that are not equal in importance to the patients and treating surgeons. Our composite outcome has been used extensively in high-profile surgical research 21-23 , including the orthopaedic fracture 24 and orthopaedic oncology literature 25 . To help readers interpret the components of our primary outcome, we have presented both deep and superficial infections individually as secondary outcomes.…”

Section: Methodsmentioning

confidence: 99%

Effect of Supplemental Perioperative Oxygen on SSI Among Adults with Lower-Extremity Fractures at Increased Risk for Infection

2022

Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

Background:Supplemental perioperative oxygen is a low-cost intervention theorized to reduce the risk of surgical site infections, but its effect among patients undergoing surgery for a tibial plateau, tibial pilon, or calcaneal fracture is unknown. We aimed to determine the effectiveness of a high fraction of inspired oxygen (FiO2, 80%) versus low FiO2 (30%) in reducing surgical site infections in these patients.Methods:A randomized controlled trial was conducted at 29 U.S. trauma centers. We enrolled 1,231 patients who were 18 to 80 years of age and had a tibial plateau, tibial pilon, or calcaneal fracture and were thought to be at elevated risk for infection based on their injury characteristics. Patients were randomized to receive 80% FiO2 (treatment group) or 30% FiO2 (control group) in the operating room and for up to 2 hours in the recovery room. The primary outcome was a composite of either deep surgical site infection (treated with surgery) or superficial surgical site infection (treated with antibiotics alone) within 182 days following definitive fixation. Secondary outcomes included these surgical site infections at 90 and 365 days after surgery.Results:The modified intention-to-treat analysis included 1,136 patients with 94% of expected follow-up through 182 days. Surgical site infection occurred in 40 (7.0%) of the patients in the treatment group and 60 (10.7%) of the patients in the control group (relative risk [RR], 0.65; 95% confidence interval [CI], 0.45 to 0.96; risk difference [RD], −3.8%; 95% CI, −7.2% to −0.4%; p = 0.03). The treatment intervention demonstrated a similar effect at 90 days (RR, 0.59; 95% CI, 0.37 to 0.93) and 365 days (RR, 0.62; 95% CI, 0.44 to 0.87). Secondary analyses demonstrated that the effect was driven by a reduction in superficial surgical site infections.Conclusions:Among tibial plateau, pilon, or calcaneal fracture patients at elevated risk for surgical site infection, a high perioperative FiO2 lowered the risk of surgical site infection. The findings support the use of this intervention, although the benefit appears to mostly be in reduction of superficial infections.Level of Evidence:Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

show abstract

“…17 Re-dosing cefazolin at 2 h and giving cephalexin and metronidazole for 48 h postpartum have been suggested to maintain appropriate tissue concentrations and reduce surgical site infection. 18,19 However, further studies validating this practice are needed before routine use can be recommended.…”

Section: Peripartum Anaesthetic Management: CDmentioning

confidence: 99%

Anaesthesia for the parturient with obesity

Patel

Habib

2021

BJA Education

View full text Add to dashboard Cite

Learning objectivesBy reading this article, you should be able to: Discuss the preoperative considerations for the parturient with obesity. Describe the neuraxial and non-neuraxial options for delivering analgesia and anaesthesia in the peripartum period. Discuss the complications associated with obesity in pregnancy.Obesity is a worldwide health problem; its prevalence is increasing in all age groups, including those of childbearing age. Currently in the UK, 23.1% of the antenatal population is obese, with prevalence being highest amongst minority ethnic groups and those from low socio-economic background. 1,2 Similar data have been reported from the USA and Australia. 3 Although once thought to be a disease of highincome countries, the rate of maternal obesity is also increasing in countries, such as India, Bangladesh and Nepal, highlighting the global nature of the disease. 4 These rising rates of obesity are a significant concern for obstetric units, as they are associated with adverse outcomes for both mother and baby. Table 1 summarises the key maternal and fetal complications associated with obesity. Most worrying is the association between maternal obesity and maternal mortality. In the UK, the Confidential Enquiry into Maternal Deaths (CEMD) reports since 2003 have consistently identified that obesity is over-represented in parturients who died from direct causes. In the most recent triennial CEMD report (2015e2017), 34% of women who died were obese and 24% were overweight. 5 Although the overall contribution of anaesthesia to maternal death remains low, obesity is a risk factor for anaesthesia-related maternal morbidity and mortality in CEMD reports since 2010. It is therefore not surprising that current guidance for managing pregnant patients with obesity advocates enhanced antepartum monitoring and detailed delivery planning with multidisciplinary involvement. As such, it is essential that all anaesthetists working on delivery units are able to anticipate and manage the challenges associated with these high-risk patients. Definition and classificationObesity is defined as an excessive or abnormal fat accumulation posing significant health risk. The WHO uses BMI to classify degree of obesity. A BMI between 18.9 and 24.9 kg m À2 is normal, BMI 25e29.99 kg m À2 is overweight and BMI >30 kg m À2 is obese. Obesity is further subclassified as Class 1 (BMI 30e34.9 kg m À2 ), Class 2 (BMI 35e39.9 kg m À2 ) and Class 3 (BMI >40 kg m À2 ). Further definitions for Class 3 obesity include

show abstract

Effect of Post-cesarean Delivery Oral Cephalexin and Metronidazole on Surgical Site Infection Among Obese Women: A Randomized Clinical Trial

Cited by 5 publications

References 0 publications

Skin preparation for prevention of surgical site infection after obstetrics and gynecological abdominal surgery: A quality improvement project

Skin preparation for prevention of surgical site infection after obstetrics and gynecological abdominal surgery: A quality improvement project

Effect of Supplemental Perioperative Oxygen on SSI Among Adults with Lower-Extremity Fractures at Increased Risk for Infection

Anaesthesia for the parturient with obesity

Contact Info

Product

Resources

About