Timing of administration of prophylactic antibiotics for caesarean section: a systematic review and meta‐analysis

Abstract

BackgroundProphylactic antibiotics reduce infectious morbidity from caesarean section. The timing of their administration, however, is a matter of controversy.ObjectivesTo examine maternal and neonatal infectious morbidity in women receiving preoperative prophylaxis compared with those receiving intraoperative administration.Search strategyMedline, Embase, Current Controlled Trials and Cochrane Central were searched from their inception dates to December 2011.Selection criteriaRandomised controlled trials of a single dose of any antibiotic comparing preoperative with intraoperative administration were selected.Data collection and analysisTrial characteristics, outcomes and quality measures, based on the Cochrane tool for risk of bias, were independently extracted. The random effect model of DerSimonian and Laird to estimate relative risks (RRs) for maternal and neonatal outcomes was used.Main resultsSix trials met the inclusion criteria, reporting on 2313 women and 2345 newborns. Preoperative administration was associated with a significant 41% reduction in the rate of endometritis compared with intraoperative administration (RR 0.59; 95% confidence interval [95% CI] 0.37–0.94; I2 0%). In the preoperative group, there were nonsignificant reductions in the rates of wound infection (RR 0.71; 95% CI 0.44–1.14; I2 0%), maternal febrile morbidity (RR 0.94; 95% CI 0.46–1.95; I2 0%), neonatal sepsis (RR 0.81; 95% CI 0.47–1.41; I2 0%), neonatal septic work-up (RR 0.93; 95% CI 0.71–1.21; I2 0%) and neonatal intensive-care unit admission (RR 0.92; 95% CI 0.65–1.28; I2 0%). There were nonsignificant increases in the rates of maternal pyelonephritis (RR 1.09; 95% CI 0.49–2.43; I2 0%) and neonatal pneumonia (RR 3.36; 95% CI 0.55–20.47; I2 0%).ConclusionsCompared with intraoperative administration, preoperative antibiotics significantly reduce the rate of endometritis. The lack of neonatal adverse effects should be cautiously interpreted given the limited power of the trials to detect such effects.

A prospective randomised clinical trial of prophylactic antibiotic in caesarean delivery and fetomaternal outcome

“…16 Smaill FM et al conducted RCT found that there was decreased incidence of maternal febrile morbidity in the group who received pre operative antibiotic. 17 In study conducted by Kalarnjini S et al no significant difference in fever was found.…”

Incidence and Risk Factors of Surgical Site Infection Among Patients Undergoing Cesarean Section

“…3,4 In many institutions, the antibiotic administration is performed after the umbilical cord has been clamped, justified by the neonatal impact of antimicrobial use. 4,5 Although antimicrobial prophylaxis reduces the risk of endometritis and incisional SSI when administered correctly, much has been discussed about its real impact due to the small number of studies and their limitations. 4,6,7 The rates of SSI after CS reported in the literature ranges from 3% to 15%, depending on the surveillance methods used to identify infections, the patient population, and the use of antibiotic prophylaxis.…”

“…4,5 Although antimicrobial prophylaxis reduces the risk of endometritis and incisional SSI when administered correctly, much has been discussed about its real impact due to the small number of studies and their limitations. 4,6,7 The rates of SSI after CS reported in the literature ranges from 3% to 15%, depending on the surveillance methods used to identify infections, the patient population, and the use of antibiotic prophylaxis. 8,9 The risk factors for SSI in association with cesarean section are many, including those case-mix issues present in the surgical patient population such as age, factors such as type of CS (elective vs emergency), and patient care practices such as antibiotic prophylaxis.…”

Timing of antibiotic prophylaxis for caesarean section

“…2 However, by their own admission, this is an update of a previous systematic review 3 which confirms that pre-incisional rather than post-cord-clamping administration of antibiotics in women undergoing caesarean section significantly reduces the rate of postoperative maternal infectious morbidity. However, meta-analyses are only as good as the quality of studies included and such repetition may perpetuate earlier errors.…”