The efficacy of ampicillin compared with ceftriaxone on preventing cesarean surgical site infections: an observational prospective cohort study

Abstract

BackgroundCesarean surgical site infections (SSIs) can be prevented by proper preoperative antibiotic prophylaxis. Differences in antibiotic selection in clinical practice exist according to obstetricians’ preferences despite clear guidelines on preoperative antibiotic prophylaxis. This study aimed to compare the efficacy of ampicillin and ceftriaxone in preventing cesarean SSIs.MethodsThe observational prospective cohort study was conducted at a tertiary hospital in Thailand from 1 January 2007 to 31 December 2012. Propensity scores for ceftriaxone prophylaxis were calculated from potential influencing confounders. The cesarean SSI rates of the ceftriaxone group vs. those of the ampicillin prophylactic group were estimated by multilevel mixed-effects Poisson regression nested by propensity score.ResultsData of 4149 cesarean patients were collected. Among these, 911 patients received ceftriaxone whereas 3238 patients received ampicillin as preoperative antibiotic prophylaxis. The incidence of incisional SSIs was (0.1% vs. 1.2%; p = 0.001) and organ space SSIs was (1.2% vs. 2.9%; p = 0.003) in the ceftriaxone group compared with the ampicillin group. After adjusting for confounders, the rate ratios of incisional and organ/space SSIs in the ceftriaxone compared with the ampicillin group did not differ (RR, 0.23; 95% CI 0.03–1.78), and (RR, 1.62; 95% CI 0.83–3.18), respectively.ConclusionThese data indicate no difference exists between ampicillin and ceftriaxone to prevent SSIs after cesarean section. Ampicillin may be used as antibiotic prophylaxis in cesarean section.Electronic supplementary materialThe online version of this article (10.1186/s13756-018-0304-6) contains supplementary material, which is available to authorized users.

Surgical site infection following cesarean section in a general hospital in Kuwait: trends and risk factors

“…However, being a major component of the skin microbiome staphylococci remain the most common organisms responsible for causing SSI [33, 39]. …”

“…Wound infections represent the most common nosocomial infections in patients undergoing surgery and are often caused by a limited range of opportunist pathogens, namely, S. aureus , E. coli , K. pneumoniae and Pseudomonas aeruginosa [33]. However, being a major component of the skin microbiome staphylococci remain the most common organisms responsible for causing SSI [33, 39].…”

“…However, despite the use of prophylactic antibiotics 98 (64.4%) of our patients developed SSI as compared to 54 who did not receive any antibiotics as prophylaxis. Of 4149 patients enrolled in an observational prospective cohort study that was conducted to directly compare the efficacy of ampicillin vs. ceftriaxone as prophylactic antibiotics in preventing post-CS SSIs, 145 (5.4%) patients developed SSI despite receiving either ceftriaxone or ampicillin [39]. This may be explained by the surgical procedure adopted by the surgeon as it has been shown that there is lower risk of wound complications when the subcutaneous thickness of sutures was greater than 2 cm (RR 1.03; 95% CI 0.36–2.76) and with suture skin closure compared with staple skin closure (adjusted OR 0.43; 95% CI 0.23–0.78) [40].…”

Antibiotic prescribing pattern in different clinical departments at Kathmandu Medical College Teaching Hospital

“…Ceftriaxone may have been used more for the treatment of Sexually Transmitted Diseases (STDs) as per Center for Disease Control and Prevention (CDC) recommendations 19 . A 5 year long study done in Thailand found Ampicillin to be equally effective as Ceftriaxone in preventing caesarean section surgical site skin infections 20 . There seems to be a need to carry on similar studies here in the future so that narrow spectrum drugs can replace the broad spectrum ones in clinical use, thereby decreasing the emergence of AMR.…”

Insidensi dan Faktor Risiko Infeksi Luka Operasi pada Bedah Obstetri dan Ginekologi di Rumah Sakit

“…Sebuah studi cohort pada wanita yang menjalani bedah C-Section di perbatasan Thai-Myanmar menunjukkan bahwa tingkat kejadian ILO sebesar 5,9% 7 . Penelitian lain di Tanzania melaporkan dari 774 pasien yang menjalani bedah C-Section, insidensi ILO tercatat sebesar 10,9% 8…”