Is It Necessary to Perform a Routine Antibiotic Prophylaxis before an Elective Surgery of Cesarean Section?

Sergei Belyaev; Larysa Nazarenko; Liliya Dubrova; Olena Fedota

doi:10.3889/oamjms.2021.6522

Authors

Sergei Belyaev Department of Genetics, Obstetrics, Gynecology and Fetal Medicine, Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine https://orcid.org/0000-0002-9597-1541
Larysa Nazarenko Department of Genetics, Obstetrics, Gynecology and Fetal Medicine, Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine
Liliya Dubrova Department of Genetics, Obstetrics, Gynecology and Fetal Medicine, Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine
Olena Fedota Department of Obstetrics and Gynecology, V. N. Karazin Kharkiv National University, Kharkiv, Ukraine

DOI:

https://doi.org/10.3889/oamjms.2021.6522

Keywords:

Cesarean section, Antibiotic prophylaxis, Infectious complications of the postpartum period

Abstract

INTRODUCTION: According to the data by World Health Organization, the broad and often insufficiently substantiated prescription of antibiotics, including for prophylactic purposes, has led to the growth of antibiotic-resistant microflora, which is a dangerous and intractable problem of modern medicine. Despite the undoubted benefits of antibiotics in the management of wound infection and endometritis after cesarean section, the routine prophylactic administration of antibacterial drugs can not only carry the risk of growth of resistant nosocomial microflora, but also have doubtful effects on the health of a newborn.

PURPOSE OF THE STUDY: The purpose of the study was to justify the possibility of carrying out elective cesarean section operations without routine antibiotic prophylaxis.

MATERIALS AND METHODS: An analysis of 333 cases of elective cesarean section operations carried out in the obstetric department in the period from 2017 to 2019 was performed. Routine antibiotic prophylaxis before surgery was not prescribed in 118 healthy patients with an uncomplicated history and a smooth course of the gestational process. The remaining 215 women received a single intravenous injection of 1 g of cefazolin sodium intraoperatively, after extraction of the fetus. A comparative analysis of the clinical groups was carried out according to the following criteria: vaginal microbiocenosis before surgical delivery, duration, and features of the operation, clinical blood count on days 1 and 5 of the post-operative period, condition of postoperative sutures, the presence of discharge from the wound, signs of infectious complications from the uterus or other organs, uterine involution rate, duration of hospital stay before and after surgery, follow-up history for 1 month after discharge from the maternity ward. The data obtained were subjected to statistical processing.

RESULTS: We have found no significant differences in the course and number of complications in the postpartum period in the compared clinical groups. The statistically significant transient leukocytosis observed on the 1^stday of the postoperative period in patients who did not undergo antibiotic prophylaxis before the surgery seems to be associated with a more pronounced adaptive reaction and was not combined with any clinical symptoms of development of infection.

CONCLUSION: No relationship has been identified between the routine prescription of antibiotics before or during an elective cesarean section and the risk of developing infectious complications in the post-operative period. Antibiotic prophylaxis before surgery should be carried out differentially, taking into account the history and features of the course of this pregnancy.

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References

Klinichnyi Protokol z Akusherskoi Dopomohy Kesariv Roztyn: Nakaz MOZ Ukrainy Vid 27.12.2011 No. 977, Kyiv; 2011. Available from: https://www.zakon.rada.gov.ua/rada/card/v0977282-11. [Last accessed on 2020 Feb 14].

Dieplinger B, Egger M, Jezek C, Heinisch-Finke C, Altendorfer C, Pernerstorfe T, et al. Implementation of a comprehensive unit-based safety program to reduce surgical site infections in cesarean delivery. Am J Infect Control. 2020;48(4):386-90. https://doi.org/10.1016/j.ajic.2020.01.016 PMid:32093979 DOI: https://doi.org/10.1016/j.ajic.2020.01.016

Ben Shoham A, Bar-Meir M, Ioscovich A, Samueloff A, Wiener- Well Y. Timing of antibiotic prophylaxis in cesarean section: Retrospective, difference-in-differences estimation of the effect on surgical-site-infection. J Matern Fetal Neonatal Med. 2019;32(5):804-8. https://doi.org/10.1080/14767058.2017.1391784 PMid:29020828 DOI: https://doi.org/10.1080/14767058.2017.1391784

Wilson RD, Caughey AB, Wood SL, Macones GA, Wrench IJ, Huang J, et al. Guidelines for antenatal and preoperative care in cesarean delivery: Enhanced recovery after surgery society recommendations (Part 1). Am J Obstet Gynecol. 2018;219(6):523.e1-5. https://doi.org/10.1016/j.ajog.2018.09.015 PMid:30240657 DOI: https://doi.org/10.1016/j.ajog.2018.09.015

Smaill FM, Gyte GM. Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section. Cochrane Database Syst Rev. 2014;10:CD007482. https://doi.org/10.1002/14651858.cd007482.pub2 PMid:25350672 DOI: https://doi.org/10.1002/14651858.CD007482.pub3

A new WHO report on antibiotic resistance. Based on the materials of the Ukrainian medical periodical. Available from: https://www.umj.com.ua/article/120095/novyj-doklad-voz-po-antibiotikorezistentnosti. [Last accessed on 2019 Dec 24].

Hayasaki M, Hanabayashi T, Ri J, Takada Y, Ito K, Noda K, et al. Pharmacokinetic and clinical studies of cefotiam in the perinatal period. Jpn J Antibiot. 1986;39(9):2497-518. PMid:3467093

Osman B, Abbas A, Ahmed MA, Abubaker MS, Adam I. Prophylactic ceftizoxime for elective cesarean delivery at Soba Hospital, Sudan. BMC Res Notes. 2013;6:57. https://doi.org/10.1186/1756-0500-6-57 PMid:23394621 DOI: https://doi.org/10.1186/1756-0500-6-57

Tapilskaya NI, Savicheva AM, Shipitsyina EV. Lactoginal for correction of abnormal vaginal microbiocenosis in pregnant woman with cervical cerclage: Clinical case and literature review. Zhurnal Akusherstva Zhenskih Bolnezney. 2016;65(6):89-95. Available from: https://cyberleninka.ru/article/n/primenenie-preparata-laktozhinal-dlya-korrektsii-narusheniya-mikrobiotsenoza-vlagalischa-u-beremennoy-s-nalozhennym-shvom-na-sheyku/viewer. https://doi.org/10.17816/jowd65689-95 DOI: https://doi.org/10.17816/JOWD65689-95

Shao J, Zhang H, Yin B, Li J, Zhu Y, Zhang Y. Risk factors for surgical site infection following operative treatment of ankle fractures: A systematic review and meta-analysis. Int J Surg. 2018;56:124-32. https://doi.org/10.1016/j.ijsu.2018.06.018 PMid:29929022 DOI: https://doi.org/10.1016/j.ijsu.2018.06.018

Ryiskeldieva VT. Uterus subinvolution as risk factors in the postnatal endometritis. Tavricheskiy Med Biologicheskiy Vestnik. 2012;15(1):212-5. Available from: http://www.dspace.nbuv.gov.ua/handle/123456789/44991.

Mulic-Lutvica A, Bekuretsion M, Bakos O, Axelsson O. Ultrasonic evaluation of the uterus and uterine cavity after normal, vaginal delivery. Ultrasound Obstet Gynecol. 2001;18(5):491-8. https://doi.org/10.1046/j.0960-7692.2001.00561.x PMid:11844171 DOI: https://doi.org/10.1046/j.0960-7692.2001.00561.x

Suliman SM, Yousef BA, Hamadelnil AA. Impact of guidelines implementation for the rational use of prophylactic antibiotics in elective cesarean sections at elqutainah teaching hospital. J Family Med Prim Care. 2020;9(1):162-7. https://doi.org/10.4103/jfmpc.jfmpc_903_19 PMid:32110584 DOI: https://doi.org/10.4103/jfmpc.jfmpc_903_19

Sway A, Wanyoro A, Nthumba P, Aiken A, Ching P, Maruta A, et al. Prospective cohort study on timing of antimicrobial prophylaxis for post-cesarean surgical site infections. Surg Infect (Larchmt). 2020;21(6):552-7. https://doi.org/10.1089/sur.2018.226 PMid:31951506 DOI: https://doi.org/10.1089/sur.2018.226

La Rosa M, Omere C, Redfern T, Abdelwahab M, Spencer N, Villarreal J, et al. The impact of low-dose versus high-dose antibiotic prophylaxis regimens on surgical site infection rates after cesarean delivery. Arch Gynecol Obstet. 2020;301(1):69-73. https://doi.org/10.1007/s00404-019-05370-y PMid:31811413 DOI: https://doi.org/10.1007/s00404-019-05370-y

Kawakita T, Huang CC, Landy HJ. Choice of prophylactic antibiotics and surgical site infections after cesarean delivery. Obstet Gynecol. 2018;132(4):948-55. https://doi.org/10.1097/aog.0000000000002863 PMid:30204697 DOI: https://doi.org/10.1097/AOG.0000000000002863

Watson D, Tita A, Dimperio L, Howard T, Harper L. Antibiotic prophylaxis for cesarean delivery among Alabama providers. South Med J. 2019;112(3):170-3. https://doi.org/10.14423/smj.0000000000000943 PMid:30830231 DOI: https://doi.org/10.14423/SMJ.0000000000000943

Gandra S, Trett A, Alvarez-Uria G, Solomkin JS, Laxminarayan R. Is the efficacy of antibiotic prophylaxis for surgical procedures decreasing? Systematic review and meta-analysis of randomized control trials. Infect Control Hosp Epidemiol. 2019;40(2):133-41. https://doi.org/10.1017/ice.2018.295 PMid:30417800 DOI: https://doi.org/10.1017/ice.2018.295

Haas DM, Morgan S, Contreras K, Kimball S. Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections. Cochrane Database Syst Rev. 2020;4(4):CD007892. https://doi.org/10.1002/14651858.cd007892.pub7 PMid:32335895 DOI: https://doi.org/10.1002/14651858.CD007892.pub7