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

Abstract

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.

Prophylactic antibiotics before cord clamping in cesarean delivery: a systematic review

“…We included 18 RCTs comparing the application of prophylactic antibiotics before vs. after cord clamping (13,(17)(18)(19)(20)(21)(22)(23)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37). The studies were conducted in the USA (17,20,29,(32)(33)(34)(35), Turkey (37), Austria (36), India (28,30), Iran (18,21), Egypt (31), Tunisia (19), Sudan (22), Italy (23) and China (13). The indication for the cesarean section, number of randomized women in treatment groups, antibiotic class, agent and dosing scheme of the administered antibiotic(s) and the actual time when the antibiotic(s) were given, are presented in Table S1.…”

“…The indication for the cesarean section, number of randomized women in treatment groups, antibiotic class, agent and dosing scheme of the administered antibiotic(s) and the actual time when the antibiotic(s) were given, are presented in Table S1. In brief, 13 studies included women with elective cesarean section solely (13,(17)(18)(19)(20)22,(29)(30)(31)(32)(33)36,37), two studies reported that more than 75% of women received elective cesarean section (21,28), and three studies were focused on non-elective cesarean section (23,34,35). The majority of studies administered a first-generation cephalosporin (cefazolin 1 g, cefazolin 2 g or cefathiamidin 2 g) (13,18,19,21,29,(31)(32)(33)(34)(35)(36)(37).…”

“…Maternal outcomes were investigated in 15 studies including 6841 women (18)(19)(20)22,23,(28)(29)(30)(31)(32)(33)(34)(35)(36)(37). There were significant reductions in composite infectious morbidity (as defined by study authors) for women who received antibiotics preoperatively as compared with those who received antibiotics after cord clamping (RR 0.72, 95% CI 0.56-0.92, nine studies, 4342 women, high quality of evidence) ( Figure 2a, Table 1).…”

Antibiotic Use and Misuse during Pregnancy and Delivery: Benefits and Risks

“…Of note, there is no prospective study investigating the mid- or long-term effect on the infant. (2) The results are not universal with some studies showing no difference in maternal complications regardless of whether antibiotics are given before skin incision or after cord clamping [4,68,69,70]. (3) The rate of postoperative morbidity in the USA is much higher than in other developed countries―probably due to high rates of obesity and diabetes.…”

Single dose antibiotic prophylaxis in elective obstetric and gynaecological surgeries-a descriptive study

“…postoperative antimicrobial prophylaxis is unnecessary as it increases cost and causes drug resistance with resistant bacteria. 27 There is insufficient evidence concerning timing of administration (preoperative versus after cord clamping) of antibiotic prophylaxis for caesarean section. Nearly all published trials since 1978 have administered the antimicrobial drug immediately after the cord is clamped.…”