Timing of perioperative antibiotics for cesarean delivery: a metaanalysis

Costantine, Maged M.; Rahman, Mahbubur; Ghulmiyah, Labib; Byers, Benjamin D.; Longo, Monica; Wen, Tony; Hankins, Gary D.V.; Saade, George R.

doi:10.1016/j.ajog.2008.06.077

Cited by 224 publications

(144 citation statements)

References 18 publications

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“…A recent meta-analysis on the timing of perioperative antibiotics for cesarean delivery concluded that there was strong evidence that antibiotic prophylaxis that is given before skin incision decreases maternal infectious complications, without affecting the infant (Costantine 2008). However, it is argued that the timing of antibiotic administration may mask septic complications in the infant (Cunningham 1983).…”

Section: Description Of the Interventionmentioning

confidence: 99%

Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section

Smaill

Gyte

2008

Cochrane Database of Systematic Reviews

150

197

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External sources• UNDP/UNFPA/WHO/World Bank (HRP), Switzerland.• The University of Liverpool, UK.NIHR NHS Cochrane Collaboration Programme Grant Scheme award for NHS-prioritised centrally-managed, pregnancy and childbirth systematic reviews: CPGS02 DIFFERENCES BETWEEN PROTOCOL AND REVIEWWe have used fixed-effect Mantel-Haenszel meta-analysis for combining data because the Handbook suggests it is more commonly used (Higgins 2008). We have modified the wording in the methods sections for Assessment of heterogeneity, Assessment of reporting biases and Data synthesis to update them with the new methods being used by the group, developed in conjunction with the Group's Statistician, Simon Gates, and Richard Riley. We have used these new methods in the review.

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Section: Description Of the Interventionmentioning

confidence: 99%

Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section

Smaill

Gyte

2008

Cochrane Database of Systematic Reviews

150

197

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“…Our results suggest that in a largely non-laboring population, the timing of prophylactic antibiotic administration does not benefit the mother or infant. Since the publication of the meta-analysis by Costantine et al, 16 two other randomized controlled trials addressing the timing of antibiotic administration at cesarean, have been published. 13,14 Both these studies did not find a significant difference in infection rate between the groups.…”

Section: Discussionmentioning

confidence: 99%

“…16,20 These results culminated in American College of Obstetricians Gynecologists issuing a Committee Opinion advocating that all women undergoing a cesarean delivery be given prophylactic antibiotics before skin incision, 17 and the National Institute for Health and Clinical Excellence advising clinicians to offer prophylactic antibiotics at cesarean before skin incision. 20 Although our study was underpowered to determine our primary endpoint, the observed decreases in endometritis (33%) and wound infection (31%) would seem to support the American College of Obstetricians Gynecologists's recommendation for administration of antibiotics before skin incision.…”

Section: Discussionmentioning

confidence: 99%

Timing of prophylactic antibiotic at cesarean section: a double-blinded, randomized trial

et al. 2013

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OBJECTIVE:The purpose was to determine the effect of the timing of prophylactic antibiotics for cesarean section on post-operative infectious complications. STUDY DESIGN: This was a prospective, double-blinded, randomized controlled trial in which patients were randomized to receive cefazolin or clindamycin either before skin incision or after cord clamp. The primary outcome was maternal infectious morbidity at 6 weeks postpartum, a composite infectious outcome, which included endometritis, urinary tract infection, wound infection and pneumonia. RESULT: Data on 896 women were analyzed; 449 randomized to skin incision, 447 to cord clamp. Postpartum infections were seen in a total of 8.4% of patients. Timing of antibiotic administration did not significantly affect any maternal postpartum infection rates or selected neonatal outcomes. CONCLUSION: Our results suggest that, in a largely non-laboring population, the timing of prophylactic antibiotic administration does not impact post-operative infectious complications of the mother. Despite being one of the largest randomized controlled trials to address this question, our study still lacked sufficient power to make definitive conclusions.

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“…Even with standard preincision prophylaxis surgical site infection occurs in 10-15% of these deliveries. [3,4] A systematic review of current published data concluded that among available interventions to further reduce postcesarean surgical site infections, azithromycin-based extendedspectrum prophylaxis (a single intravenous dose of azithromycin in addition to standard prophylaxis) might reduce the risk of postcesarean infection compared to standard cephalosporin alone. [5] In a randomized clinical trial of over 2000 women undergoing unscheduled and non-elective cesarean delivery, compared to placebo, we found that adding azithromycin to standard preincision prophylaxis reduced surgical site infection by 50% (12 versus 6.1%), with a relative risk (RR) of 0.51 and 95% confidence interval (CI) of 0.38 to 0.68; p<0.001.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Postcesarean Maternal Infection in a Trial of Extended-Spectrum Antibiotic Prophylaxis: Correction

2017

Obstetrics &Amp; Gynecology

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Objective-To identify maternal clinical risk factors for postcesarean maternal infection in a randomized clinical trial of preincision extended-spectrum antibiotic prophylaxis.Methods-We conducted a planned secondary analysis of a randomized clinical trial. Patients were ≥ 24 weeks of gestation and delivered by cesarean delivery after a minimum of 4 hours of ruptured membranes or labor. All participants received standard preincision prophylaxis and were randomized to receive azithromycin or placebo. The primary outcome for this analysis is maternal infection: a composite outcome of endometritis, wound infection (superficial or deep), or other infections occurring up to 6 weeks postpartum. Maternal clinical characteristics associated with maternal infection, after controlling for azithromycin assignment, were identified. These maternal factors were included in a multivariable logistic regression model for maternal infection. HHS Public AccessResults-Of 2,013 patients, 1,019 were randomized to azithromycin. Overall, 177 (8.8%) had postcesarean maternal infection. In the final adjusted model, compared to the reference groups, women of Black race-ethnicity, with a nontransverse uterine incision, with duration of membrane rupture > 6 hours, and surgery duration > 49 minutes, were associated higher odds of maternal infection (all with adjusted odds ratios of ∼2); azithromycin was associated with lower odds of maternal infection (adjusted odds ratio of 0.4, 95% confidence interval 0.3-0.6.Conclusions-Despite preincision azithromycin-based extended spectrum antibiotic prophylaxis, postcesarean maternal infection remains a significant source of morbidity. Recognition of risk factors may help guide innovative prevention strategies.

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Timing of perioperative antibiotics for cesarean delivery: a metaanalysis

Cited by 224 publications

References 18 publications

Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section

Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section

Timing of prophylactic antibiotic at cesarean section: a double-blinded, randomized trial

Risk Factors for Postcesarean Maternal Infection in a Trial of Extended-Spectrum Antibiotic Prophylaxis: Correction

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