Reducing the incidence of infection after caesarean section: implications of prophylaxis with antibiotics for hospital resources.

Mugford, Miranda; Kingston, J. E.; Chalmers, Ian

doi:10.1136/bmj.299.6706.1003

Cited by 95 publications

(32 citation statements)

References 7 publications

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“…Based on systematic reviews of over eighty clinical trials, this benefit applies to both non-elective and elective (scheduled) procedures 4,26. Because antibiotic prophylaxis shortens overall length of hospitalization and reduces treatment costs associated with cesarean, it is highly cost-effective 27–28. Consequently, antibiotic prophylaxis is recommended for all women undergoing cesarean section 7.…”

Section: Resultsmentioning

confidence: 99%

Emerging Concepts in Antibiotic Prophylaxis for Cesarean Delivery

Tita

Rouse

Blackwell

et al. 2009

Obstetrics &Amp; Gynecology

123

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Objective-To review the current status of antibiotic prophylaxis for cesarean delivery, newly evolving strategies to enhance the effectiveness of antibiotic prophylaxis in reducing post-cesarean infection, and the implications of the emerging practices.Data Sources-We conducted a full PubMed (January 1966-July 2008) search using the key words "cesarean section" and "antibiotic prophylaxis." A total of 277 articles were identified and supplemented by a bibliographic search.Methods of Study Selection-We selected a total of 15 studies which included all published clinical trials, meta-analyses of clinical trials, and observational studies evaluating either the timing of antibiotics or the use of extended-spectrum prophylaxis. We also reviewed nine reports involving national recommendations or technical reviews supporting current standards for antibiotic prophylaxis.Tabulation, Integration, and Results-We conducted an analytic review and tabulation of selected studies without further meta-analysis. Although current guidelines for antibiotic prophylaxis recommend the administration of narrow-spectrum antibiotics (cefazolin) after clamping of the umbilical cord, the data suggest that antibiotic administration prior to surgical incision or the use of extended-spectrum regimens (involving azithromycin or metronidazole) after cord clamp may reduce postcesarean maternal infection by up to 50%. However, their impact relative to each other has not been studied. In addition, their impact on neonatal infection or infection with resistant organisms warrants further study. Conclusion-The use of either cefazolin alone prior to surgical incision or an extended-spectrum regimen after cord clamp appears to be associated with a reduction in postcesarean maternal infection. Confirmatory studies focusing additionally on neonatal outcomes and the impact on resistant organisms, as well as studies comparing both strategies, are needed.

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Section: Resultsmentioning

confidence: 99%

Emerging Concepts in Antibiotic Prophylaxis for Cesarean Delivery

Tita

Rouse

Blackwell

et al. 2009

Obstetrics &Amp; Gynecology

123

View full text Add to dashboard Cite

show abstract

“…(37) Our analysis of data on administration of antibiotics in labour showed that under 6% of the ALSPAC mothers who underwent caesarean received prophylaxis. Early life antibiotic exposure disrupts the developing intestinal microbiome and causes increased adiposity in laboratory animals.…”

Section: Discussionmentioning

confidence: 99%

Association of caesarean delivery with child adiposity from age 6 weeks to 15 years

et al. 2013

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Objectives To assess associations of caesarean section with body mass from birth through adolescence. Design Longitudinal birth cohort study, following subjects up to 15 years of age. Setting and Participants Children born in 1991–1992 in Avon, UK who participated in the Avon Longitudinal Study of Parents and Children [ALSPAC] (n = 10,219). Outcome measures Primary outcome: standardized measures of body mass (weight-for length z-scores at 6 weeks, 10, and 20 months; and Body Mass Index [BMI] z-scores at 38 months, 7, 9, 11, and 15 years). Secondary outcome: Categorical overweight or obese (BMI >= 85th percentile) for age and gender, at 38 months, 7, 9, 11, and 15 years. Results Of the 10,219 children, 926 (9.06%) were delivered by caesarean section. Those born by caesarean had lower birth weights than those born vaginally (−46.1g, 95% CI: 14.6 to 77.6 g; p = 0.004). In mixed multivariable models adjusting for birth weight, gender, parental body mass, family sociodemographics, gestational factors and infant feeding patterns, caesarean delivery was consistently associated with increased adiposity, starting at six weeks (+0.11 SD units, 95% CI 0.03 to 0.18; p=0.005), through age 15 (BMI z-score increment + 0.10 SD units, 95% CI 0.001 to 0.198; p=0.042). By age 11 caesarean–delivered children had 1.83 times the odds of overweight or obesity (95% CI: 1.24 to 2.70; p=0.002). When the sample was stratified by maternal pre-pregnancy weight, the association among children born of overweight/obese mothers was strong and long-lasting. In contrast, evidence of an association among children born of normal weight mothers was weak. Conclusion Caesarean delivery is associated with increased body mass in childhood and adolescence. Research is needed to further characterize the association in children of normal weight women. Additional work is also needed to understand the mechanism underlying the association, which may involve relatively enduring changes in the intestinal microbiome.

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“…Effectiveness data from overviews have the advantage that the confidence interval around the point estimate of clinical effect is usually narrower than that from an individual trial and the result may be more generalisable 23. Typically the economic analyst would take the point estimate of effect from the overview as the base case value and use the confidence interval as the relevant range for sensitivity analysis (see section 9).…”

Section: The Working Party's Methodsmentioning

confidence: 99%