Infections complicating low-risk cesarean sections in community hospitals: Efficacy of antimicrobial prophylaxis

Ehrenkranz, N. Joel; Blackwelder, William C.; Pfaff, Sandra J.; Poppe, Dolores; Yerg, Diane E.; Kaslow, Richard A.

doi:10.1016/0002-9378(90)90381-g

Cited by 59 publications

(30 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The Misgav Ladach [9] addressed the surgical technique in attempt to reduce of the operative time, blood loss and post operative complications. Along with good surgical technique [10,11], proper anesthesia, maximal aseptic approach [12,13] and vigorous homeostasis, routine cervical dilatation was considered as a reasonable approach to maximise uterine drainage. Uterine drainage will assumingly prevent fluid and blood stasis inside the uterine cavity and subsequently reduce metritis [14].…”

Section: Introductionmentioning

confidence: 99%

Routine cervical dilatation during elective cesarean delivery – Is it really necessary?

Koifman

Harlev

Press

et al. 2009

The Journal of Maternal-Fetal & Neonatal Medicine

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 99%

Routine cervical dilatation during elective cesarean delivery – Is it really necessary?

Koifman

Harlev

Press

et al. 2009

The Journal of Maternal-Fetal & Neonatal Medicine

View full text Add to dashboard Cite

show abstract

“…Although Ureaplasma urealyticum is very commonly isolated from the upper genital tract and infected wounds, it is unclear whether it is a pathogen in this setting (Roberts 1993). Wound infections caused by Staphylococcus aureus and coagulase negative staphylococci arise from contamination of the wound with the endogenous flora of the skin at the time of surgery (Emmons 1988).…”

Section: Description Of the Conditionmentioning

confidence: 99%

Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section

Smaill

Gyte

2008

Cochrane Database of Systematic Reviews

151

197

View full text Add to dashboard Cite

External sources• UNDP/UNFPA/WHO/World Bank (HRP), Switzerland.• The University of Liverpool, UK.NIHR NHS Cochrane Collaboration Programme Grant Scheme award for NHS-prioritised centrally-managed, pregnancy and childbirth systematic reviews: CPGS02 DIFFERENCES BETWEEN PROTOCOL AND REVIEWWe have used fixed-effect Mantel-Haenszel meta-analysis for combining data because the Handbook suggests it is more commonly used (Higgins 2008). We have modified the wording in the methods sections for Assessment of heterogeneity, Assessment of reporting biases and Data synthesis to update them with the new methods being used by the group, developed in conjunction with the Group's Statistician, Simon Gates, and Richard Riley. We have used these new methods in the review.

show abstract

“…Infection is described as an important complication of surgery and is a costly complication of cesarean deliveries 7,10 . Antimicrobial prophylaxis is one of the preventive strategies used to decrease infectious complications; on the other hand, inappropriate and indiscriminate use of prophylactic antibiotics may increase costs through unnecessary drug …”

Section: Discussionmentioning

confidence: 99%

“…Antibiotic prophylaxis is recommended in order to decrease infectious complications in high risk cesarean sections 1,2,26 . In 1990, EHRENKRANZ et al 10 demonstrated that routine timely antibiotic prophylaxis might be associated with a 70% to 75% reduction of risk of either endometritis or wound infection in low-risk cesarean sections. CHELMOW et al 8 confirmed these findings in a meta-analysis demonstrating that prophylactic antibiotic use in low-risk cesarean sections was associated with a significant reduction in postoperative fever and endometritis.…”

mentioning

confidence: 99%

“…We also took administrative measures to make proper prophylaxis practically automatic and required surgeons to expressly request, in writing, any prescription that did not follow the protocol. The almost 50% decrease in cefazolin vial use also pleased the administrators who played a very important role in actively supporting the policy and making sure that only 1-g cefazolin vials would be dispensed from pharmacy.Infection is described as an important complication of surgery and is a costly complication of cesarean deliveries 7,10 . Antimicrobial prophylaxis is one of the preventive strategies used to decrease infectious complications; on the other hand, inappropriate and indiscriminate use of prophylactic antibiotics may increase costs through unnecessary drug …”

mentioning

confidence: 99%

See 1 more Smart Citation

Successful control program to implement the appropriate antibiotic prophylaxis for cesarean section

Fonseca¹,

Sofia²,

Quintana³

et al. 2008

Rev. Inst. Med. trop. S. Paulo

View full text Add to dashboard Cite

SUMMARYObjective: Describe implementation of a successful program to reduce doses (cefazolin 2 to 1 g) used for antimicrobial prophylaxis. Methods: Evaluation of an intervention program to reduce prophylactic antimicrobial doses. The intervention included weekly staff discussions, automatic dispensation of 1g-vial of cefazolin by the pharmacy unless expressly requested by surgeon and increase in post-discharge surveillance as a strategy to reassure surgeons of the safety of the reduction. In the pre and post intervention periods, a prospective study of antimicrobial consumption and surgical site infections were measured. Results: There were 5, 164 and 5,204 deliveries in 2001-2002 and 2003-2004, respectively; 1,524 (29.5%) and 1,363 (26%) were cesarean sections. There was a 45% decrease in cefazolin vials used on average per cesarean section (2.29 to 1.25). Patients evaluated increased from 16% to 67% and the SSI rates in both periods were 3.34% to 2.42%, respectively. Conclusion: An ample intervention, including administrative and educational measures, led to high compliance with dose reduction and saved more than US$4,000 in cefazolin, considered important because government reimbursement in Brazil for cesarean section is $80. KEYWORDS:Antimicrobial prophylaxis; Cesarean section; Compliance; Cefazolin; Surgical site infection.Major postoperative infectious complications such as endometritis and surgical site infection are important causes of maternal morbidity 10 . Antibiotic prophylaxis is recommended in order to decrease infectious complications in high risk cesarean sections 1,2,26 . In 1990, EHRENKRANZ et al. 10 demonstrated that routine timely antibiotic prophylaxis might be associated with a 70% to 75% reduction of risk of either endometritis or wound infection in low-risk cesarean sections. CHELMOW et al. 8 confirmed these findings in a meta-analysis demonstrating that prophylactic antibiotic use in low-risk cesarean sections was associated with a significant reduction in postoperative fever and endometritis. More recently, in a cost-analysis study this same group 7 concluded that administration of prophylactic antibiotics for elective cesarean delivery reduced costs by US$30.66 per case resulting in cost savings for elective cesarean delivery. Most clinical guidelines 2,9,11,13,23,27 advocate the use of a single dose of 1 to 2 g of cefazolin right after the clamping of the cord in cesarean deliveries. Increasing healthcare costs have led (or forced) hospitals and clinics to review procedures, in order to adjust their budgets. Also, concerns with antimicrobial resistance have pressured infection control specialists to decrease antimicrobial usage. There is a variation of dosage of cefazolin in the randomized controlled trials and both 1 and 2 grams are doses suggested in guidelines. To achieve the aim of the most cost effectiveness under limited resources, a single dose of 1 gram administered immediately after cord clamping among women undergoing cesarean section is the most appropriate. Despite th...

show abstract

Infections complicating low-risk cesarean sections in community hospitals: Efficacy of antimicrobial prophylaxis

Cited by 59 publications

References 13 publications

Routine cervical dilatation during elective cesarean delivery – Is it really necessary?

Routine cervical dilatation during elective cesarean delivery – Is it really necessary?

Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section

Successful control program to implement the appropriate antibiotic prophylaxis for cesarean section

Contact Info

Product

Resources

About