Prophylactic antibiotics in caesarean delivery before or after cord clamping – protecting the mother at the expense of the infant’s microbiota?

Winther, Acr; Axelsson, Paul; Clausen, Tine D.; Løkkegaard, Ecl

doi:10.1111/1471-0528.15960

Cited by 10 publications

(12 citation statements)

References 15 publications

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“…Thus the infection prevalence after non-elective CS should presumably be higher than that reported for unspecified CS [ 1 , 5 ]. A recent study by Winther et al with review of medical records of women giving birth by elective CS only, performed at our facility during a similar time period as the current study, found a combined infection prevalence of 2.1%, when administering antibiotics after cord clamping [ 8 ]. This could indicate that the sterility procedures, population, and the conditions at our facility may differ from those in previous studies.…”

Section: Discussionmentioning

confidence: 64%

“…Clinical studies have found a 1.5–2.4 times higher risk of surgical-site infection after non-elective CS compared to elective CS, presumably as a consequence of ongoing labor being common with contamination of bacteria from the birth canal and limited time for proper preparation of the patient or the surgeon [ 3 , 6 , 7 ]. Recent studies have implied that rates of serious maternal infections requiring contacts to a hospital are low when giving prophylactic antibiotics after cord clamping [ 8 ]. Even then, infections are manageable with oral antibiotic treatment in most cases.…”

Section: Introductionmentioning

confidence: 99%

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Postoperative infections after non-elective cesarean section – a retrospective cohort study of prevalence and risk factors at a single center in Denmark administering prophylactic antibiotics after cord clamping

Kuhr

Axelsson

Andersen

et al. 2022

BMC Pregnancy Childbirth

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Background Mothers giving birth by non-elective cesarean section have considerably higher risk of developing postoperative infection, than mothers giving birth by elective cesarean section. Meta-analyses have shown that the risk of infection is reduced when administering antibiotics at least 30 min prior to skin incision rather than after cord clamping. If given prior to incision, antibiotics are present in the neonatal bloodstream for up to 24 h after delivery, with early exposure to antibiotics potentially disturbing development of the gut microbiome. We aimed to retrospectively assess the prevalence of postoperative infection after non-elective cesarean section at a single labor ward administering antibiotics after cord clamping, additionally investigating risk factors for developing postoperative infections. Methods In this retrospective cohort study, we included a total of 2,725 women giving birth by non-elective cesarean section in 2010–2017 with a review of records for prenatal risk factors, labor management, and perinatal outcomes. The primary outcomes were a main composite infection of development of either endometritis, surgical-site infection, or sepsis in conjunction with a relevant antibiotic prescription. Secondary outcomes included infection of unknown focus, mastitis, urinary tract infection, and pneumonia. Results A total of 88 patients developed a main composite infection (3.2%). These infections subdivide into endometritis (n = 37/2725, 1.4%), surgical-site infection (n = 35/2725, 1.3%) and sepsis (n = 15/2725, 0.6%). We found a high body mass index (aOR = 3.38, 95%CI 1.93–5.92) and intrapartum fever (aOR = 2.26, 95%CI 1.22–4.59) to be independent risk-factors for developing postoperative infection after non-elective cesarean section. Furthermore, we found delivery by a more expedient emergency grade 2 cesarean section (aOR = 0.61 95%CI 0.37–0.998) compared to grade 3 to be a protective factor for developing postoperative infection after non-elective cesarean section. Conclusion In a labor ward administering antibiotics after cord clamping at non-elective cesarean births, we find a low prevalence of main composite infections when compared to estimates from meta-analyses on the topic. We conclude that administration of prophylactic antibiotics after cord clamping appears to result in acceptable rates of postoperative infection and avoids transplacental-transmission of antibiotics to the infant.

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Section: Discussionmentioning

confidence: 64%

Section: Introductionmentioning

confidence: 99%

Postoperative infections after non-elective cesarean section – a retrospective cohort study of prevalence and risk factors at a single center in Denmark administering prophylactic antibiotics after cord clamping

Kuhr

Axelsson

Andersen

et al. 2022

BMC Pregnancy Childbirth

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show abstract

“…We would like to thank Dr Moron for his excellent commentary to our recent article in BJOG regarding the effect of prophylactic antibiotics in caesarean delivery on the infant microbiota . We agree that there is strong evidence that administration before cord clamping reduces the relative risk of surgical site infections and endometritis, all other factors being equal.…”

mentioning

confidence: 82%

“…We would like to thank Dr Moron for his excellent commentary 1 to our recent article in BJOG regarding the effect of prophylactic antibiotics in caesarean delivery on the infant microbiota. 2 We agree that there is strong evidence that administration before cord clamping reduces the relative risk of surgical site infections and endometritis, all other factors being equal. However, we argue that in Denmark, and probably in many other countries with similar healthcare structures, the absolute risk of a postoperative infection is becoming increasingly small regardless of antibiotic prophylaxis timing.…”

Section: Sirmentioning

confidence: 99%

Re: Infant microbiota and antibiotic prophylaxis in caesarean delivery

Winther

Axelsson

Clausen

et al. 2019

BJOG

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“…Most obstetric guidelines recommend intravenous antibiotic prophylaxis before skin incision as opposed to after cord clamping. However, some surgeons argue against this recommendation, because they believe that the benefits to the mother do not outweigh the potentially detrimental effects on the infant [14]. A Cochrane Database Systematic Review confirmed that preoperatively administered prophylactic antibiotics for caesarean section significantly decrease the incidence of composite maternal postpartum infectious morbidity, but likewise acknowledge that: 'further research may be needed to elucidate short-and long-term adverse effects for neonates' [15].…”

mentioning

confidence: 99%

Prophylactic antibiotics in prevention of infection after operative vaginal or caesarean delivery

Zeitlinger

Berger

2020

Clinical Microbiology and Infection

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Prophylactic antibiotics in caesarean delivery before or after cord clamping – protecting the mother at the expense of the infant’s microbiota?

Cited by 10 publications

References 15 publications

Postoperative infections after non-elective cesarean section – a retrospective cohort study of prevalence and risk factors at a single center in Denmark administering prophylactic antibiotics after cord clamping

Postoperative infections after non-elective cesarean section – a retrospective cohort study of prevalence and risk factors at a single center in Denmark administering prophylactic antibiotics after cord clamping

Re: Infant microbiota and antibiotic prophylaxis in caesarean delivery

Prophylactic antibiotics in prevention of infection after operative vaginal or caesarean delivery

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