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

Abstract

BackgroundProphylactic 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.MethodsWe 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.ResultsThe 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).ConclusionsGiving prophylactic antibiotics before skin incision reduces risk of postoperative infection, in particular of endometritis.Trial registrationPan African Clinical Trial Registry PACTR201311000610495.Date of trial registration: 12th August 2013.

The Prevalence, Risk Factors, and Bacterial Profile of Cesarean Surgical Site Infections at a University Teaching Hospital in South Western Uganda

“…Pre-operative antibiotics use for Cesarean was found to be protective against development of post Cesarean wound sepsis. Administration of pre-operative antibiotics within 30 to 60 minutes of skin incision reduces risk of postoperative infection by almost 70% and maximizes concentrations at the surgical site [5,[11][12][13][14].…”

“…Surgical site infections can be prevented by giving prophylactic antibiotics and strict adherence to antibiotic prophylaxis and infection control guidelines can reduce postpartum sepsis incidence by 70% [5]. Implementation of evidence-based measures such as prophylactic antibiotic administration before Cesarean section significantly reduces surgical site infections and as thus women undergoing Cesarean section should receive the prophylactic antibiotics [10,11]. Intravenous prophylactic antibiotics for Cesarean section given preoperatively compared with administration after cord clamp significantly reduces the incidence of surgical site infections [11].…”

“…Implementation of evidence-based measures such as prophylactic antibiotic administration before Cesarean section significantly reduces surgical site infections and as thus women undergoing Cesarean section should receive the prophylactic antibiotics [10,11]. Intravenous prophylactic antibiotics for Cesarean section given preoperatively compared with administration after cord clamp significantly reduces the incidence of surgical site infections [11]. World Health Organization (WHO) recommends use of pre-Cesarean delivery prophylactic antibiotics 30 to 60 minutes prior to operative skin incision to reduce the risk of postoperative infection [11][12][13][14].…”

“…Intravenous prophylactic antibiotics for Cesarean section given preoperatively compared with administration after cord clamp significantly reduces the incidence of surgical site infections [11]. World Health Organization (WHO) recommends use of pre-Cesarean delivery prophylactic antibiotics 30 to 60 minutes prior to operative skin incision to reduce the risk of postoperative infection [11][12][13][14]. We therefore set out to evaluate the prevalence, bacterial profile and risk factors of wound sepsis following caesarean section at Mbarara Regional Referral hospital.…”

Prophylactic Antibiotics during Emergency Cesarean Section

“…(17) A systematic review by Cochrane Database in 2010 supports the recommendation that prophylactic antibiotics should be routinely administered to all women undergoing cesarean section to prevent infection as it considerably decreases the incidence of wound infection, endometritis and serious infection complications by 60-70%. (18) Methods An observational study was conducted in the department of OBGYN of CSM Hospital run by Thane Municipal corporation in Mumbai Maharashtra in which 100 patients undergoing emergency cesarean section were enrolled. Patients were randomly allocated into two arms.…”