Antibiotic prophylaxis in low-risk cesarean section. [Antibiotic prophylaxis in a priori cesarean sections without a high risk of infection. Experiences of a Tunisian maternity department]. Randomized trial of prophylactic antibiotic therapy after preterm amnion rupture. Reduction of post-cesarean section infectious morbidity by means of antibiotic irrigation. Choice of antibiotics for infection prophylaxis in emergency cesarean sections in low-income countries: a cost-benefit study in Mozambique. A double-blind randomized controlled trial on the use of prophylactic antibiotics in patients undergoing elective caesarean section. A study on prophylactic antibiotics in cesarean sections--is it worthwhile? Antibiotic irrigation prophylaxis in the high-risk cesarean section patient. Reducing infections among women undergoing cesarean section in Colombia by means of continuous quality improvement methods.
This prospective study was undertaken in an effort to evaluate the role of systemic antibiotic prophylaxis in elective abdominal delivery. Eighty-two patients undergoing elective cesarean section who were not in labor and who did not have ruptured membranes were assigned on a randomized, double-blind basis to receive a three-dose perioperative course of either placebo or ampicillin. Postoperatively, patients were evaluated for the development of infection-related complications. Patients in the antibiotic group experienced less febrile morbidity, had lower fever indices and developed fewer operative-site infections than did patients in the control group. No patient in either group, however, developed a potentially life-threatening infection, and all infected patients responded promptly to parenteral antibiotic therapy. Because of the limited morbidity associated with elective cesarean section in this patient population, it is concluded that the theoretical risks of antibiotic prophylaxis outweigh the expected benefits. This study was conducted to evaluate the effect of antibiotic prophylaxy on decreasing the frequency of postoperative infections after cesarean sections performed in cases with no prior indication of a high risk of infection.
                A prospective randomized study included 269 cesarean sections without a high risk of infection performed in the Maternity and Neonatology Ward of the Sousse Hospital from February 1991 to July 1991. The patients were randomly divided into two groups. One group received an antibiotic prophylactic treatment including cephapirine, gentamicin and metronidazole) and the second group was given no treatment.
                Antibiotic prophylactic therapy led to a reduction of infectious morbidity after cesarean section in patients without high risk o infection from 33% to 11%. A 66% rate of efficacy was observed. In addition, antibiotics given in this context led to substantial cost reduction both by reducing the cost of antibiotics prescribed in the postoperative period and by reducing the number of days of hospitalization, and thus total cost.
                This study demonstrated the effectiveness of antibiotic prophylaxy for cesarean sections in patients without a high risk of infection. Nevertheless, a reevaluation of the antibiotic protocols and a rigorous operative procedure are essential. Our purpose was to determine whether maternal administration of prophylactic ampicillin or erythromycin after preterm amnion rupture is associated with maternal or neonatal benefits.
                Women with singleton pregnancies between 24 and 33 weeks 6 days of gestation were eligible if they had no immediate indication for delivery. After giving informed consent, patients were randomized either to receive ampicillin (erythromycin if penicillin allergic) until delivery or to enter a control group. Women whose cervical cultures were positive for either group B streptococci or Neisseria gonorrhoeae received treatment. Tocolytics and corticosteroids were not used.
                From January 1990 to February 1992 117 patients (antibiotics 59, control 58) were recruited and analyzed. Prophylactic antibiotics were associated with a longer latent phase (mean 12 vs 7.0 days, p = 0.004) and fewer maternal infectious complications (29% vs 60%, p = 0.001). A higher incidence of neonatal necrotizing enterocolitis was observed in the treatment group (14% vs 3.5%, p = 0.05). Other neonatal complications, including death, were lower in the treatment group, but none attained statistical significance (p = 0.09 to 0.33).
                The use of prophylactic antibiotics in selected patients after preterm amnion rupture appears to have a demonstrable maternal benefit. Large, multicenter trials may demonstrate a significant neonatal benefit or confirm any adverse outcomes. The effectiveness of antibiotic irrigation in reducing post-cesarean section infectious morbidity was studied in a prospective, randomized, double-blind trial. One hundred twenty-eight patients were divided into three groups and irrigated with either cefoxitin solution, cephapirin solution, or saline. Following delivery of the placenta, the uterine cavity and incision, bladder flap, pelvic gutters, and subcutaneous tissue of the patients were irrigated. There was a significant reduction in total infectious morbidity (p less than 0.02) and wound infection (p less than 0.04) when antibiotic use was compared to the saline control. No statistical difference in the effectiveness of the two antibiotics could be demonstrated. No adverse effects were noted. Antibiotic irrigation is a safe and effective method in reducing infectious morbidity of the parturient patient. There is a need to assess the cost-benefit of different models of antibiotic administration for the prevention of post cesarean infection, particularly in resource-scarce settings.
                Randomized, nonblinded comparative study of a single combined preoperative dose of gentamicin and metronidazole vs. a post cesarean scheme for infection prophylaxis.
                Pregnant women (n = 288) with indication for emergency cesarean section were randomly allotted to two groups. Group 1 (n = 143) received the single, combined dose of prophylactic antibiotics and group 2 (n = 145) received, over 7 days, the postoperative standard scheme of antibiotics followed in the department. Both groups were followed up during 7 days for detection of signs of wound infection, endometritis, peritonitis and urinary tract infection.
                Prevalence of postoperative infection, mean hospital stay and costs of antibiotics used.
                Women completing the study (n = 241) were distributed into group 1 (n = 116) and group 2 (n = 125). No significant difference was found neither in the prevalence of postoperative infection nor in the mean hospital stay. No death occurred. The cost of the single dose of prophylactic antibiotics was less than one-tenth of the cost of the standard postoperative scheme.
                In our setting, the administration of a single dose of 160 mg of gentamicin in combination with 500 mg of metronidazole before emergency cesarean section for prevention of infection is clinically equivalent to existing conventional week-long postoperative therapy, but at approximately one-tenth of the cost. In a double-blind randomized controlled study 232 patients undergoing elective lower segment caesarean section were randomly allocated to receive a pre-operative prophylactic dose of a combination of crystalline penicillin and chloramphenicol or a placebo. The two groups were comparable in terms of patient characteristics and operation variables. The group receiving antibiotics had significantly fewer febrile and infectious morbid events and thus spent fewer days in hospital than the group receiving the placebo. To study the effect of single-dose prophylactic Augmentin on patients undergoing cesarean section.
                Three hundred and twenty women undergoing cesarean section were randomized into two groups in a prospective, double-blind, placebo-controlled study. One hundred and sixty women were allocated to receive a single-dose of 1.2 g Augmentin at induction of anesthesia and 160 were allocated to a control group who received placebo. The following post-cesarean outcome parameters were compared between the two groups: duration of hospital stay, febrile morbidity, urine microscopy, bacteriuria, endometritis, and wound infection.
                There was no significant difference between the two groups with respect to the duration of post-operative hospital stay or the incidence of febrile morbidity, endometritis, and wound infection. However, the study group had fewer post-operative abnormalities in urine microscopy (p < 0.05) and bacteriuria (p < 0.01). The bacterial flora were also different between the two groups.
                Single-dose prophylactic Augmentin did not produce any clinically significant improvement in the post-operative course of patients undergoing cesarean section. If proper surgical techniques are followed in association with closed rectus sheath drainage, it is unlikely that any trial of antibiotics will be able to demonstrate any clinically significant outcome. Two hundred twenty-three women who underwent cesarean section delivery were studied to assess the effectiveness of operative antibiotic irrigation in preventing postoperative uterine infection. Patients were prospectively randomized into high-risk and low-risk groups according to length of labor, and received irrigation with either a 2 gm solution of cefamandole or normal saline solution, or no irrigation. Infection rates of 48.6% and 54.8% were observed in high-risk patients given either saline solution or no irrigation, respectively. Three of 27 high-risk patients (11.1%) given antibiotic irrigation developed metritis. The authors find this method of preventing infection to be advantageous in terms of both efficacy and minimization of antibiotic exposure. Improving obstetric care in resource-limited countries is a major international health priority.
                To reduce infection rates after cesarean section by optimizing systems of obstetric care for low-income women in Colombia by means of quality improvement methods.
                Multidisciplinary teams in 2 hospitals used simple methods to improve their systems for prescribing and administering perioperative antibiotic prophylaxis. Process indicators were the percentage of women in whom prophylaxis was administered and the percentage of these women in whom it was administered in a timely fashion. The outcome indicator was the surgical site infection rate.
                Before improvement, prophylaxis was administered to 71% of women in hospital A; 24% received prophylaxis in a timely fashion. Corresponding figures in hospital B were 36% and 50%. Systems improvements included implementing protocols to administer prophylaxis to all women and increasing the availability of the antibiotic in the operating room. These improvements were associated with increases in overall and timely administration of prophylaxis (P<.001) in both hospitals by time series analysis, with adjustment for volume and case mix. After improvement, overall and timely administration of prophylaxis was 95% and 96% in hospital A and 89% and 96% in hospital B. In hospital A, the surgical site infection rate decreased immediately after the improvements (P<.001). In hospital B, the infection rate began a downward trend before the improvements that continued after their implementation (P =.04).
                Simple quality improvement methods can be used to optimize obstetric services and improve outcomes of care in resource-limited settings.
The data were too few and of insufficient quality to make any recommendations for practice. Future research on antibiotic prophylaxis for operative vaginal delivery is needed to conclude whether it is useful for reducing postpartum morbidity.