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Salmanov AG, Artyomenko VV, Shchedrov AO, Prishchepa AP, Padchenko AS, Korniyenko SM, Kovalyshyn OA, Zarichanska KV, Nastradina NM, Kokhanov IV. Epidemiology and risk factors for healthcare-associated maternal peripartum infections in Ukraine: results a multicenter study. POLSKI MERKURIUSZ LEKARSKI : ORGAN POLSKIEGO TOWARZYSTWA LEKARSKIEGO 2024; 52:408-414. [PMID: 39360720 DOI: 10.36740/merkur202404104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/04/2024]
Abstract
OBJECTIVE Aim: To estimate the frequency of different types of healthcare-associated maternal peripartum infections and their risk factors among women in Ukraine. PATIENTS AND METHODS Materials and Methods: Multicenter prospective cohort study was conducted in nine regional perinatal centers of Ukraine between January 1, 2021, to December 31, 2023. The criteria for specific healthcare-associated maternal peripartum infections (endometritis, episiotomy infection, and maternal sepsis) site were adapted from the CDC/NHSN case definitions. Surveillance was performed during the hospitalization period and up to 30 days after hospital discharge. RESULTS Results: A total of 3600 deliveries by the vaginal route were performed during the study period, 600 (16.7%) maternal peripartum infections were observed. Of all maternal peripartum infection cases, 79.7% were detected after hospital discharge. The most common maternal peripartum infections include endometritis (54.8%), episiotomy infections (34.4%), and maternal sepsis (10.8%). According to the multivariate logistic regression analysis, the body mass index >25, placenta previa, premature rupture of membrane, prolonged rupture of membranes, manual removal of the placenta, multiple vaginal examinations, bacterial vaginosis, aerobic vaginitis, gestational diabetes mellitus, and anemia during pregnancy were independent risk factors for maternal peripartum infections. CONCLUSION Conclusions: Results this study suggest a high prevalence of healthcare-associated maternal peripartum infections in Ukraine. Several factors have been associated with increased risk of maternal peripartum infections, including pre-existing maternal conditions, placenta previa, prolonged rupture of membranes, and spontaneous or provider-initiated conditions during labour and childbirth.
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Affiliation(s)
- Aidyn G Salmanov
- Shupyk National Healthcare University of Ukraine , Kyiv, Ukraine; INSTITUTE OF PEDIATRICS, OBSTETRICS AND GYNECOLOGY OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE, KYIV, UKRAINE
| | | | - Andrii O Shchedrov
- SCHOOL OF MEDICINE OF V. N. KARAZIN KHARKIV NATIONAL UNIVERSITY, KHARKIV, UKRAINE
| | | | | | | | | | | | | | - Igor V Kokhanov
- Shupyk National Healthcare University of Ukraine , Kyiv, Ukraine
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Salmanov AG, Shchedrov AO, Prishchepa AP, Artyomenko V, Korniyenko SM, Rud VO, Kolesnik AV. Postpartum infections and antimicrobial resistance of responsible pathogens in Ukraine: results a multicenter study (2020-2022). WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2024; 77:375-382. [PMID: 38691775 DOI: 10.36740/wlek202403101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
OBJECTIVE Aim: To determine the current prevalence of postpartum infections and antimicrobial resistance and antimicrobial resistance of responsible pathogens in Ukraine. PATIENTS AND METHODS Materials and Methods: Multicenter prospective cohort study was conducted from January 2020 to December 2022 in fifteen hospitals from twelve regions of Ukraine. Definitions of healthcare- associated postpartum infection were adapted from the Centers for Disease Control and Prevention's National Healthcare Safety Network. Antibiotic susceptibility was done by the disc diffusion test as recommended by EUCAST. RESULTS Results: Among 21,968 women, 6,175 (28.1%) postpartum infections were observed. Of all postpartum infection cases, 83.1% were detected after hospital discharge. The postpartum infection rates were 17.3% after cesarean section and 10.8% after vaginal delivery. The most common postpartum infection types were endometritis (17.3%), followed by urinary tract Infection (3.5%), mastitis (3.4%), surgical site infection (excluding endometritis) (2.4%), and episiotomy site infection (1.5%). The predominant postpartum infection pathogens in Ukraine were: Escherichia coli (10.4%), Enterococcus spp. (9.6%), Staphylococcus aureus (6.7%), Pseudomonas aeruginosa (5.8%), Enterobacter spp. (5.8%). In our study pathogens of postpartum infection had differently levels of resistance to antibiotics. CONCLUSION Conclusions: Our results indicate that postpartum infections requiring medical attention are common in Ukraine and that most postpartum infections occur after hospital discharge, so that use of routine inpatient surveillance methods alone will lead to underestimation of postpartum infection rates. Optimizing the antibiotic prophylaxis may reduce the burden of postpartum infection, but prevention is the key element.
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Affiliation(s)
- Aidyn G Salmanov
- SHUPYK NATIONAL HEALTHCARE UNIVERSITY OF UKRAINE, KYIV, UKRAINE; INSTITUTE OF PEDIATRICS, OBSTETRICS AND GYNECOLOGY OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE, KYIV, UKRAINE
| | - Andrii O Shchedrov
- SCHOOL OF MEDICINE OF V. N. KARAZIN KHARKIV NATIONAL UNIVERSITY, KHARKIV, UKRAINE
| | | | | | | | - Victor O Rud
- NATIONAL PIROGOV MEMORIAL MEDICAL UNIVERSITY, VINNYTSIA, UKRAINE
| | - Anna V Kolesnik
- LUTSK ACADEMY OF RECREATION TECHNOLOGIES AND LAW, LUTSK, UKRAINE
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Sirilak T, Kanjanarat P, Nochaiwong S, Katip W. Incidence of postpartum infections and outcomes associated with antibiotic prophylaxis after normal vaginal birth. Front Med (Lausanne) 2022; 9:939421. [PMID: 36148454 PMCID: PMC9485810 DOI: 10.3389/fmed.2022.939421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
Antibiotic consumption accounted for approximately 15–20% of total drug costs in Thailand. From 2017 to 2018, 24.86% of Thai women who experienced vaginal delivery during normal term labour received antibiotics for postpartum infection. The Thai national practice guidelines set the target use of antibiotic prophylaxis in women following vaginal delivery of normal term labour to be no more than 10%. This study aimed to determine the incidence of postpartum infections and the outcomes and factors associated with antibiotic prophylaxis in women following vaginal delivery. The prospective cohort study was collected from 909 eligible patients who delivered infants in 7 secondary hospitals in Chiang Mai from July 2020 to February 2021. Antibiotic prescribing data and infections in women experiencing vaginal delivery during normal term labour were collected. The incidence of postpartum infections was calculated at 2 periods, 48 h and 6 weeks, after labour. Factors associated with the prescription of antibiotic prophylaxis in vaginal delivery were analysed using multivariate logistic regression. The results showed that the prevalence of antibiotic prescribing was 12.87% in a cohort of 117 patients. Postpartum infection was reported in 3 of 117 patients with antibiotics prophylaxis and 11 of 792 without antibiotics, with no statistically significant difference (RR: 1.04, 95% CI: 0.26–4.14; p = 0.956). Postpartum hygiene self-care practices were collected in the 6th week. The results found that there were no statistical differences in mean scores for all questions on postpartum hygiene self-care practices between the infected and non-infected groups (p-value > 0.05). One of the factors associated with antibiotic prophylaxis was third to fourth degree of tear and episiotomy (OR: 7.72, 95% CI: 1.13–52.75; p = 0.037 and OR: 2.41, 95% CI: 1.24–4.70; p = 0.010, respectively). There was no significance difference in postpartum infection among patients receiving antibiotic and those who did not receive antibiotics. Third to fourth degree of tear and episiotomy were significantly factors related to antibiotic prophylaxis in women with vaginal delivery after labour. This study supports practice guidelines and helps healthcare team to be assured on the use of antibiotics in no more than 10% of women experiencing normal vaginal delivery.
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Affiliation(s)
| | - Penkarn Kanjanarat
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Faculty of Pharmacy, Pharmacoepidemiology and Statistics Research Center (PESRC), Chiang Mai University, Chiang Mai, Thailand
- *Correspondence: Penkarn Kanjanarat,
| | - Surapon Nochaiwong
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Faculty of Pharmacy, Pharmacoepidemiology and Statistics Research Center (PESRC), Chiang Mai University, Chiang Mai, Thailand
| | - Wasan Katip
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Wasan Katip,
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Plessis AHD, van Rooyen DR, ten Ham-Baloyi W. Screening and managing women with chorioamnionitis in resource-constrained healthcare settings: Evidence-based recommendations. Midwifery 2022; 107:103287. [DOI: 10.1016/j.midw.2022.103287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/20/2022] [Accepted: 02/10/2022] [Indexed: 10/19/2022]
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Sychareun V, Sihavong A, Machowska A, Onthongdee X, Chaleunvong K, Keohavong B, Eriksen J, Hanson C, Vongsouvath M, Marrone G, Brauner A, Mayxay M, Kounnavong S, Lundborg CS. Knowledge, Attitudes, Perception and Reported Practices of Healthcare Providers on Antibiotic Use and Resistance in Pregnancy, Childbirth and Children under Two in Lao PDR: A Mixed Methods Study. Antibiotics (Basel) 2021; 10:antibiotics10121462. [PMID: 34943674 PMCID: PMC8698782 DOI: 10.3390/antibiotics10121462] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/18/2021] [Accepted: 11/23/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Overuse and misuse of antibiotics contribute unnecessarily to antibiotic resistance (ABR), and are thereby global health threats. Inappropriate prescriptions of antibiotics during pregnancy, delivery and early childhood are widespread across the world. This study aimed to assess knowledge, attitudes, and reported practices of healthcare providers (HCPs) and to explore their perceptions regarding antibiotic use and ABR related to pregnancy, childbirth, and children under two in Lao PDR. Methods: This is a mixed methods study with data collection in 2019 via structured interviews among 217 HCPs (medical doctors/assistant doctors, midwives/nurses, pharmacists/assistant pharmacists and drug sellers), who prescribed/dispensed antibiotics in one rural and one urban district in Vientiane province and individual qualitative interviews with 30 HCPs and stakeholders. Results: Of the HCPs, 36% had below average knowledge regarding antibiotic use and ABR, and 67% reported prescribing antibiotics for uncomplicated vaginal delivery. Half of the HCPs did not believe that their prescribing contributed to ABR, and only 9% had participated in antibiotic education. Conclusion: A substantial number of HCPs had suboptimal knowledge and prescribed antibiotics unnecessarily, thereby contributing to ABR. Continuous education and regular supervision of HCPs is recommended to improve the use of antibiotics related to pregnancy, childbirth, and young children.
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Affiliation(s)
- Vanphanom Sychareun
- Faculty of Public Health, University of Health Sciences (UHS), Vientiane 7444, Laos;
| | - Amphoy Sihavong
- Vientiane Capital Health Department, Ministry of Health, Vientiane 01030, Laos;
| | - Anna Machowska
- Department of Global Public Health, Karolinska Institutet, 17177 Stockholm, Sweden; (J.E.); (C.H.); (G.M.); (C.S.L.)
- Correspondence:
| | - Xanded Onthongdee
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane 01030, Laos; (X.O.); (S.K.)
| | - Kongmany Chaleunvong
- Institute of Research and Education Development, UHS, Ministry of Health, Vientiane 01030, Laos; (K.C.); (M.M.)
| | - Bounxou Keohavong
- Food and Drug Department, Ministry of Health, Vientiane 01030, Laos;
| | - Jaran Eriksen
- Department of Global Public Health, Karolinska Institutet, 17177 Stockholm, Sweden; (J.E.); (C.H.); (G.M.); (C.S.L.)
- Department of Infectious Diseases/Venhalsan, Stockholm South General Hospital, 11883 Stockholm, Sweden
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, 17177 Stockholm, Sweden; (J.E.); (C.H.); (G.M.); (C.S.L.)
| | - Manivanh Vongsouvath
- Lao-Oxford-Mahosot Hospital-Welcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane 01000, Laos;
| | - Gaetano Marrone
- Department of Global Public Health, Karolinska Institutet, 17177 Stockholm, Sweden; (J.E.); (C.H.); (G.M.); (C.S.L.)
| | - Annelie Brauner
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 17177 Stockholm, Sweden;
- Division of Clinical Microbiology, Karolinska University Hospital, 17164 Solna, Sweden
| | - Mayfong Mayxay
- Institute of Research and Education Development, UHS, Ministry of Health, Vientiane 01030, Laos; (K.C.); (M.M.)
- Lao-Oxford-Mahosot Hospital-Welcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane 01000, Laos;
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford OX3 7LG, UK
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane 01030, Laos; (X.O.); (S.K.)
| | - Cecilia Stålsby Lundborg
- Department of Global Public Health, Karolinska Institutet, 17177 Stockholm, Sweden; (J.E.); (C.H.); (G.M.); (C.S.L.)
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Sharma S, Kumari N, Sengupta R, Malhotra Y, Bhartia S. Rationalising antibiotic use after low-risk vaginal deliveries in a hospital setting in India. BMJ Open Qual 2021; 10:bmjoq-2021-001413. [PMID: 34344734 PMCID: PMC8336128 DOI: 10.1136/bmjoq-2021-001413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/13/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND In 2017, a postoperative multidrug resistant case of urinary tract infection made obstetricians at Sitaram Bhartia Institute of Science and Research introspect the antibiotic usage in labouring mothers. Random case file reviews indicated overuse and variability of practice among care providers. This prompted us to explore ways to rationalise antibiotic use. METHODS A multidisciplinary team of obstetricians, paediatricians and quality officers was formed to run this improvement initiative at a private hospital facility in India. Review of literature advocated formulating a departmental antibiotic policy. Creating this policy and implementing it using improvement methodology helped us rationalise antibiotic usage. INTERVENTIONS We aimed to reduce the use of antibiotics from 42% to less than 10% in uncomplicated vaginal deliveries. We tested a series of sequential interventions using the improvement methodology of Plan-Do-Study-Act (PDSA) cycles, an approach recommended by the Institute for Healthcare Improvement. Learning from the PDSA cycle of the previous intervention helped decide the subsequent change ideas. The interventions included creation of a departmental antibiotic policy, staff engagement, and modification in documentation, concept of dual responsibility and team huddles as feedback opportunities. Information was analysed to understand the progress and improvement with change ideas. RESULTS Background analysis revealed that antibiotic usage ranged from 24% to 69% and average rate of antibiotic prophylaxis was high (42.28%) in low-risk uncomplicated vaginal deliveries. The sequential changes resulted in reduction in antibiotic usage to 10% in the target population by 4 months. Sustained improvement was noted in the following months. CONCLUSION We succeeded in implementing a departmental antibiotic policy aligning it with existing international guidelines and our local challenges. Antibiotic stewardship was one of the first major steps in our journey to avoid multidrug-resistant infections. Sustaining outcomes will involve continuous feedback to ensure engagement of all stakeholders in a hospital setting.
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Affiliation(s)
- Shakti Sharma
- Obstetrics and Gynecology, Sitaram Bhartia Institute of Science and Research, New Delhi, Delhi, India
| | - Nikita Kumari
- Obstetrics and Gynecology, Sitaram Bhartia Institute of Science and Research, New Delhi, Delhi, India
| | - Rinku Sengupta
- Obstetrics and Gynecology, Sitaram Bhartia Institute of Science and Research, New Delhi, Delhi, India
| | - Yashika Malhotra
- Quality, Sitaram Bhartia Institute of Science and Research, New Delhi, Delhi, India
| | - Saru Bhartia
- Quality, Sitaram Bhartia Institute of Science and Research, New Delhi, Delhi, India
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Salerno T, Siqueira AK, Pinto JPDAN, Cunha MDLRDSD, Silvestre PK, Condas LAZ, Lara GHB, Pereira JG, Silva AVD, Listoni FJP, Martins LDSA, Motta RG, Ribeiro MG. Safety issues of raw milk: evaluation of bacteriological and physicochemical characteristics of human milk from a bank in a teaching hospital, focusing on Staphylococcus species. Rev Inst Med Trop Sao Paulo 2021; 63:e54. [PMID: 34231819 PMCID: PMC8266376 DOI: 10.1590/s1678-9946202163054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/22/2021] [Indexed: 11/27/2022] Open
Abstract
Many infants are nurtured with milk supplied by human banks, whose
bacteriological and physical-chemical profiles are a major issue. We
investigated the bacteriological and physical-chemical characteristics, as well
as genotypic and phenotypic and profiles of Staphylococcus
species isolated from 240 samples of breast milk from a bank in a teaching
hospital. Dornic acidity of milk revealed that 95.4% (229/240) had acceptable
limits (< 8.0 oD). Caloric intake showed a wide variation in cream
content (4%), fat (4%) and energy values (559.81 Kcal/L).
Staphylococcus (105/186 or 56.5%) and
Enterobacter (25/186 or 13.4%) were the most prevalent
genera, although other microorganisms were identified, including
Klebsiella pneumoniae and Pseudomonas
aeruginosa. Amoxicillin/clavulanic acid (125/157 or 79.6%),
vancomycin (115/157 or 73.2%), and cephalexin (112/157 or 71.3%) were the most
effective antimicrobials. High resistance rates of isolates were found to
penicillin G (141/157 or 89.8%), ampicillin (135/157 or 86%), and oxacillin
(118/157 or 75.2%). Multidrug resistance to ≥ 3 antimicrobials occurred in 66.2%
(123/186) of the isolates. Residues of microbial multiplication inhibitory
substances were found in 85% (204/240) of samples. Among the
coagulase-positive-CPS and negative-CoNS staphylococci, the
mecA gene was detected in 53.3% (8/15) and 75% (30/40),
respectively. Genes sea, seb and sec were
detected in 20% (3/15) of CPS, while tsst-1 was detected in
13.34% (2/15). In addition, 13.3% (2/15) of S. aureus were
toxin-producers. Genes sea, seb and sec were
detected in 90% (36/40), 5% (2/40) and 15% (6/40) CoNS, respectively.
Enterotoxin production was identified in 5% (2/40) of CoNS. The identification
of multidrug-resistant bacteria, staphylococci species toxin-producers harboring
methicillin-resistance genes, and residues of microbial multiplication
inhibitory substances reinforce the need for a continuous vigilance of milk
quality offered to infant consumption by human banks.
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Affiliation(s)
- Tatiana Salerno
- Universidade Estadual Paulista, Faculdade de Medicina Veterinária e Zootecnia, Departamento de Produção Animal e Medicina Veterinária Preventiva, Botucatu, São Paulo, Brazil
| | - Amanda Keller Siqueira
- Universidade Estadual Paulista, Faculdade de Medicina Veterinária e Zootecnia, Departamento de Produção Animal e Medicina Veterinária Preventiva, Botucatu, São Paulo, Brazil
| | - José Paes de Almeida Nogueira Pinto
- Universidade Estadual Paulista, Faculdade de Medicina Veterinária e Zootecnia, Departamento de Produção Animal e Medicina Veterinária Preventiva, Botucatu, São Paulo, Brazil
| | | | | | - Larissa Anuska Zeni Condas
- Universidade Estadual Paulista, Faculdade de Medicina Veterinária e Zootecnia, Departamento de Produção Animal e Medicina Veterinária Preventiva, Botucatu, São Paulo, Brazil
| | - Gustavo Henrique Batista Lara
- Universidade Estadual Paulista, Faculdade de Medicina Veterinária e Zootecnia, Departamento de Produção Animal e Medicina Veterinária Preventiva, Botucatu, São Paulo, Brazil
| | - Juliano Gonçalves Pereira
- Universidade Estadual Paulista, Faculdade de Medicina Veterinária e Zootecnia, Departamento de Produção Animal e Medicina Veterinária Preventiva, Botucatu, São Paulo, Brazil
| | - Aristeu Vieira da Silva
- Universidade de Feira de Santana, Departamento de Ciências Biológicas, Feira de Santana, Bahia, Brazil
| | - Fernando José Paganini Listoni
- Universidade Estadual Paulista, Faculdade de Medicina Veterinária e Zootecnia, Departamento de Produção Animal e Medicina Veterinária Preventiva, Botucatu, São Paulo, Brazil
| | - Lorrayne de Souza Araújo Martins
- Universidade Estadual Paulista, Faculdade de Medicina Veterinária e Zootecnia, Departamento de Produção Animal e Medicina Veterinária Preventiva, Botucatu, São Paulo, Brazil
| | - Rodrigo Garcia Motta
- Universidade Estadual Paulista, Faculdade de Medicina Veterinária e Zootecnia, Departamento de Produção Animal e Medicina Veterinária Preventiva, Botucatu, São Paulo, Brazil
| | - Márcio Garcia Ribeiro
- Universidade Estadual Paulista, Faculdade de Medicina Veterinária e Zootecnia, Departamento de Produção Animal e Medicina Veterinária Preventiva, Botucatu, São Paulo, Brazil
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Yang W, Fan X, Du X, Wang Z, Wang M, Cao N. The value of inflammatory factors and red blood cell immune indices in predicting perinatal infection in hypertensive women after cesarean section. Am J Transl Res 2021; 13:2990-2996. [PMID: 34017466 PMCID: PMC8129257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/21/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This study was conducted to explore the predictive value of inflammatory factors and red blood cell (RBC) immune indices in perinatal infection of women with pregnancy-induced hypertension after cesarean section. METHODS Eighty women with pregnancy-induced hypertension and perinatal infection after cesarean section were enrolled as the study group. Another 80 pregnant women with hypertension but without perinatal infection during cesarean section were included as the control group. The two groups were compared in terms of interleukin-1β (IL-1β), IL-6, IL-10, transformation growth factor-β (TGF-β), tumor necrosis factor-α (TNF-α), γ-interferon (IFN-γ), immune adhesion inhibitor (FEIR), immune adhesion promotion factor (FEER), and immune complex rosette (RBC-ICR) levels. The mothers in the study group were grouped according to the level of white blood cells, and the differences in related indicators of women in different inflammatory states were compared. Finally, the correlation between inflammatory factors and RBC-related immune indices was calculated. The differences in inflammatory factors and RBC-related immune indices were evaluated among different infection types. The ROC curve of IL-1β, IL-6, IL-10 and FEIR, FEER, RBC-ICR for infection prediction was plotted. RESULTS The study group showed significantly higher maternal levels of inflammatory factors and FEIR and lower FEER and RBC-ICR than the control group (P<0.05). There was a significant correlation between inflammatory factors and RBC-related immune indices (P<0.05), and there was little difference in inflammatory factors and RBC-related immune indices among different infection types (P>0.05). Inflammatory factors and RBC-related immune indices exhibited good predictive value for perinatal infection of women with pregnancy-induced hypertension. CONCLUSION Prior to perinatal infection, the inflammatory factors and the RBC indices of women with hypertension and cesarean section are significantly altered. Monitoring these indicators can be used to evaluate maternal prognosis.
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Affiliation(s)
- Wenju Yang
- Obstetrics Department, Liaocheng Dongchangfu District Maternity and Child Health Hospital Liaocheng 252000, Shandong Province, China
| | - Xiaocui Fan
- Obstetrics Department, Liaocheng Dongchangfu District Maternity and Child Health Hospital Liaocheng 252000, Shandong Province, China
| | - Xia Du
- Obstetrics Department, Liaocheng Dongchangfu District Maternity and Child Health Hospital Liaocheng 252000, Shandong Province, China
| | - Zhen Wang
- Obstetrics Department, Liaocheng Dongchangfu District Maternity and Child Health Hospital Liaocheng 252000, Shandong Province, China
| | - Min Wang
- Obstetrics Department, Liaocheng Dongchangfu District Maternity and Child Health Hospital Liaocheng 252000, Shandong Province, China
| | - Ningning Cao
- Obstetrics Department, Liaocheng Dongchangfu District Maternity and Child Health Hospital Liaocheng 252000, Shandong Province, China
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Still No Substantial Evidence to Use Prophylactic Antibiotic at Operative Vaginal Delivery: Systematic Review and Meta-Analysis. Obstet Gynecol Int 2020; 2020:1582653. [PMID: 32934656 PMCID: PMC7479451 DOI: 10.1155/2020/1582653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 05/01/2020] [Indexed: 12/22/2022] Open
Abstract
Background Postpartum maternal infection is still a common problem worldwide, mainly due to obstetric risk factors. The use of prophylactic antibiotic at operative vaginal delivery (OVD), taking it as a standalone risk factor, has been controversial. The purpose of this review was to rigorously evaluate the association of OVD with postpartum infection and shed light on such highly controversial issue. Methods A computer-based literature search was done mainly in the databases of PUBMED, HINARI health research, and the Cochrane library. Systematic review and meta-analysis were done by including 14 articles published between 1990 and August 2019. Results The average absolute risk of postpartum infection at OVD from seven large cohort studies was 1%. Few studies showed a weak association of OVD with postpartum infection without being adjusted to perineal wound, but the pooled meta-analysis showed statistically significant association with non-OVD. In the included randomized trial, 97% of the study participants had perineal wound for whom repairs were performed; the risks of maternal infection and perineal wound breakdown were comparable, and maternal infections other than perineal wound infection did not show significant difference between prophylactic antibiotic and placebo groups. The majority of included studies demonstrated a strong association of postpartum infection and perineal wound dehiscence with episiotomy and perineal tear. Conclusion Both the relative and absolute risks of postpartum infection at OVD are extremely low unless accompanied by episiotomy and 3rd/4tht degree perineal tear. From previous studies, there is no substantial evidence to use prophylactic antibiotic at OVD, but episiotomy and perineal tear.
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Song H, Hu K, Du X, Zhang J, Zhao S. Risk factors, changes in serum inflammatory factors, and clinical prevention and control measures for puerperal infection. J Clin Lab Anal 2019; 34:e23047. [PMID: 31883276 PMCID: PMC7083398 DOI: 10.1002/jcla.23047] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/08/2019] [Accepted: 07/15/2019] [Indexed: 12/14/2022] Open
Abstract
Background To investigate the risk factors and changes in serum inflammatory factors in puerperal infection, and propose clinical prevention measures. Methods A total of 240 subjects with suspected puerperal infection treated in our hospital from January 2017 to December 2017 were collected, among which puerperal infection was definitely diagnosed in 40 cases, and it was excluded in 40 cases. Levels of interleukin‐6 (IL‐6), tumor necrosis factor‐α (TNF‐α), and high‐sensitivity C‐reactive protein (hs‐CRP) were compared between the two groups, and the change trends of IL‐6 and hs‐CRP were recorded. Results Levels of IL‐6, hs‐CRP, and TNF‐α in puerperal infection group were higher than those in non‐infection group (P < .05). Levels of IL‐6 and hs‐CRP at enrollment and 1‐3 days after enrollment in infection group were higher than those in non‐infection group (P < .05). The body mass index >25, placenta previa, placenta accreta, postpartum hemorrhage, premature rupture of membrane, gestational diabetes mellitus, and anemia during pregnancy were relevant and independent risk factors for puerperal infection. Puerperal infection occurred in uterine cavity, vagina, pelvic peritoneum, pelvic tissue, incision, urinary system, etc, and gram‐negative (G+) bacteria were dominated in pathogens. Conclusion The inflammatory response of patients with puerperal infection is significantly enhanced.
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Affiliation(s)
- Hongbi Song
- Department of Obstetrics, Guizhou Provincial People's Hospital, Guiyang, China
| | - Keli Hu
- Department of Obstetrics, Guizhou Provincial People's Hospital, Guiyang, China
| | - Xuyuan Du
- Department of Obstetrics, Guizhou Provincial People's Hospital, Guiyang, China
| | - Jiao Zhang
- Department of Obstetrics, Guizhou Provincial People's Hospital, Guiyang, China
| | - Shu Zhao
- Department of Obstetrics, Guizhou Provincial People's Hospital, Guiyang, China
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New Heteroleptic Ruthenium(II) Complexes with Sulfamethoxypyridazine and Diimines as Potential Antitumor Agents. Molecules 2019; 24:molecules24112154. [PMID: 31181667 PMCID: PMC6600252 DOI: 10.3390/molecules24112154] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 05/30/2019] [Accepted: 06/01/2019] [Indexed: 11/21/2022] Open
Abstract
Two new complexes of Ru(II) with mixed ligands were prepared: [Ru(bpy)2smp](PF6) (1) and [Ru(phen)2smp](PF6) (2), in which smp = sulfamethoxypyridazine; bpy = 2,2′-bipyridine; phen = 1,10-phenanthroline. The complexes have been characterized by elemental and conductivity analyses; infrared, NMR, and electrospray ionization mass spectroscopies; and X-ray diffraction of single crystal. Structural analyses reveal a distorted octahedral geometry around Ru(II) that is bound to two bpy (in 1) or two phen (in 2) via their two heterocyclic nitrogens and to two nitrogen atoms from sulfamethoxypyridazine—one of the methoxypyridazine ring and the sulfonamidic nitrogen, which is deprotonated. Both complexes inhibit the growth of chronic myelogenous leukemia cells. The interaction of the complexes with bovine serum albumin and DNA is described. DNA footprinting using an oligonucleotide as substrate showed the complexes’ preference for thymine base rich sites. It is worth notifying that the complexes interact with the Src homology SH3 domain of the Abl tyrosine kinase protein. Abl protein is involved in signal transduction and implicated in the development of chronic myelogenous leukemia. Nuclear magnetic resonance (NMR) studies of the interaction of complex 2 with the Abl-SH3 domain showed that the most affected residues were T79, G97, W99, and Y115.
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Tandon AN, Dalal AR. A Randomized, Open-labelled, Interventional Study to Evaluate the Incidence of Infection with or Without Use of Prophylactic Antibiotics in Patients of Episiotomy in a Normal Vaginal Delivery. J Obstet Gynaecol India 2018; 68:294-299. [PMID: 30065545 PMCID: PMC6046672 DOI: 10.1007/s13224-017-1041-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 07/31/2017] [Indexed: 11/30/2022] Open
Abstract
AIM The aim of this study was to compare the incidence of infection in patients of episiotomy with or without the use of prophylactic antibiotics and to compare other morbidities associated with episiotomy and the role of antibiotics in their prevention and treatment. DESIGN This open-labelled, randomized, interventional study was conducted in the Department of Obstetrics and Gynaecology at BYL Nair Charitable Hospital, Mumbai, Maharashtra, from October 2014 to October 2015. Three hundred women subjected to episiotomy during normal vaginal delivery in the labour ward from BYL Nair Charitable Hospital fulfilling specific criteria were enrolled in this study and randomly divided into two study groups A and B. In group A, 5-day course of prophylactic antibiotics including tablet cefixime 200 mg BD and tablet metronidazole 400 mg TDS was given, and in group B, prophylactic antibiotics were not given. The two groups were followed up for a period of 5-days postpartum and observed for signs and symptoms of infection. MAIN OUTCOME Presence of infection, i.e. presence of any positive finding including redness/pain/swelling/wound discharge or wound gape in group A (with antibiotics), was 0.7%, and in group B (without antibiotics) was 2%. The p value by Fischer's exact test was 0.622 which is not significant. Hence, there was no increased incidence of infection in either group, whether antibiotics were given or not. CONCLUSION To summarise, in our study, it was seen that prophylactic antibiotics did not decrease the incidence of infection in episiotomy following normal vaginal delivery in uncomplicated cases, but further studies are required to evaluate this topic and come to a more definitive conclusion.
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Affiliation(s)
- Amrita N. Tandon
- Department of Obstetrics and Gynaecology, BYL Nair Charitable Hospital, Mumbai, India
| | - Asha R. Dalal
- Department of Obstetrics and Gynaecology, BYL Nair Charitable Hospital, Mumbai, India
- Department of Obstetrics and Gynaecology, Sir H.N. Reliance Foundation and Research Centre, Mumbai, India
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13
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Jaalama M, Palomäki O, Vuento R, Jokinen A, Uotila J. Prevalence and Clinical Significance of Streptococcus dysgalactiae subspecies equisimilis (Groups C or G Streptococci) Colonization in Pregnant Women: A Retrospective Cohort Study. Infect Dis Obstet Gynecol 2018; 2018:2321046. [PMID: 29973773 PMCID: PMC6008822 DOI: 10.1155/2018/2321046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 04/26/2018] [Indexed: 11/22/2022] Open
Abstract
Objectives Little is known about the significance of Streptococcus G or C colonization in pregnant women. The objective of this study was to assess whether vaginal Streptococcus group G or C colonization detected in late pregnancy increases the infectious morbidity of the mother or newborn. Methods A total of 15,114 rectovaginal cultures taken at 35-37 weeks of pregnancy were analyzed at Tampere University Hospital, Finland, between 2012 and 2014. From this laboratory data, all Streptococcus G or C-positive cultures were included to study maternal and neonatal infectious morbidity after delivery. This study population was compared to women with a positive Streptococcus B culture and to women with a negative culture. Results The prevalence of Streptococcus G or C colonization was 2.9%. Significantly more postpartum endometritis was found in this study group. No association was found between colonization and neonatal bacteremia. Conclusions Streptococcus G or C colonization is associated with postpartum endometritis. More research is needed to clarify if antibiotic prophylaxis is reasonable for this group during delivery.
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Affiliation(s)
- M. Jaalama
- Department of Obstetrics and Gynecology, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | - O. Palomäki
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
| | - R. Vuento
- Department of Microbiology, Fimlab Laboratories Ltd., Tampere, Finland
| | - A. Jokinen
- Department of Obstetrics and Gynecology, Central Finland Health Care District, Jyväskylä, Finland
| | - J. Uotila
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
- School of Medicine, University of Tampere, Finland
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Miller EC, Gallo M, Kulick ER, Friedman AM, Elkind MSV, Boehme AK. Infections and Risk of Peripartum Stroke During Delivery Admissions. Stroke 2018; 49:1129-1134. [PMID: 29678837 PMCID: PMC5916037 DOI: 10.1161/strokeaha.118.020628] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 02/24/2018] [Accepted: 03/20/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Peripartum strokes during delivery admissions are rare but have high maternal morbidity. Infections have been proposed as a possible stroke trigger. We hypothesized that women who had infections diagnosed at the time of delivery admission would have higher risk of stroke during their delivery hospitalization. METHODS We conducted a case-control study using state inpatient administrative databases for California (2007-2011), Florida (2009-2011), and New York (2009-2011). Women whose admission included a vaginal or cesarean delivery, with a new diagnosis of stroke during the admission, were considered cases and were randomly matched to 3 in-state controls by age/admission year and presence and severity of hypertensive disorders of pregnancy. The primary exposure of interest was infection of any type present on admission. Secondary exposures included race/ethnicity, payer status, delivery method, and known vascular risk factors such as chronic hypertension, diabetes mellitus, smoking, alcohol abuse, hypercoagulable states, coagulopathies, and renal disease. We used multivariable conditional logistic regression to estimate the odds ratios and 95% confidence intervals for the association of infections and known vascular risk factors with stroke risk. RESULTS A total of 455 cases (mean age, 29.8), of whom 195 (42.9%) had hypertensive disorders of pregnancy, were matched with 1365 controls. Infection of any type present on admission increased the odds of stroke diagnosis during the admission (adjusted odds ratio, 1.74; 95% confidence interval, 1.29-2.35). Risk was higher for genitourinary infections (adjusted odds ratio, 2.56; 95% confidence interval, 1.25-5.24) and sepsis (adjusted odds ratio, 10.4; 95% confidence interval, 2.15-20.0). The association between infection and stroke during delivery admission did not differ by the presence of hypertensive disorders of pregnancy. CONCLUSIONS Infections present on admission increased stroke risk during delivery admissions in women with and without hypertensive disorders of pregnancy. The results were driven by genitourinary infections and sepsis. Infections may be an underrecognized precipitant of peripartum stroke.
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Affiliation(s)
- Eliza C Miller
- From the Department of Neurology, Vagelos College of Physicians and Surgeons (E.C.M., E.R.K., M.S.V.E., A.K.B.)
| | - Marisa Gallo
- Department of Epidemiology, Mailman School of Public Health (M.G., E.R.K., M.S.V.E., A.K.B.)
- Columbia University, New York, NY; and Pfizer, Inc, New York, NY (M.G.)
| | - Erin R Kulick
- From the Department of Neurology, Vagelos College of Physicians and Surgeons (E.C.M., E.R.K., M.S.V.E., A.K.B.)
- Department of Epidemiology, Mailman School of Public Health (M.G., E.R.K., M.S.V.E., A.K.B.)
| | - Alexander M Friedman
- Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons (A.M.F.)
| | - Mitchell S V Elkind
- From the Department of Neurology, Vagelos College of Physicians and Surgeons (E.C.M., E.R.K., M.S.V.E., A.K.B.)
- Department of Epidemiology, Mailman School of Public Health (M.G., E.R.K., M.S.V.E., A.K.B.)
| | - Amelia K Boehme
- From the Department of Neurology, Vagelos College of Physicians and Surgeons (E.C.M., E.R.K., M.S.V.E., A.K.B.)
- Department of Epidemiology, Mailman School of Public Health (M.G., E.R.K., M.S.V.E., A.K.B.)
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Nababan HY, Islam R, Mostari S, Tariqujjaman M, Sarker M, Islam MT, Moucheraud C. Improving quality of care for maternal and newborn health: a pre-post evaluation of the Safe Childbirth Checklist at a hospital in Bangladesh. BMC Pregnancy Childbirth 2017; 17:402. [PMID: 29202714 PMCID: PMC5716057 DOI: 10.1186/s12884-017-1588-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 11/22/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Bangladesh has achieved major gains in maternal and newborn survival, facility childbirth and skilled birth attendance between 1991 and 2010, but excess maternal mortality persists. High-quality maternal health care is necessary to address this burden. Implementation of WHO Safe Childbirth Checklist (SCC), whose items address the major causes of maternal deaths, is hypothesized to improve adherence of providers to essential childbirth practices. METHOD The SCC was adapted for the local context through expert consultation meetings, creating a total of 27 checklist items. This study was a pre-post evaluation of SCC implementation. Data were collected over 8 months at Magura District Hospital. We analysed 468 direct observations of birth (main analysis using 310 complete observations and sensitivity analysis with the additional 158 incomplete observations) from admission to discharge. The primary outcome of interest was the number of essential childbirth practices performed before compared to after SCC implementation. The change was assessed using adjusted Poisson regression models accounting for clustering by nurse-midwives. RESULT After checklist introduction, significant improvements were observed: on average, around 70% more of these safe childbirth practices were performed in the follow-up period compared to baseline (from 11 to 19 out of 27 practices). Substantial increases were seen in communication between nurse-midwives and mothers (counselling), and in management of complications (including rational use of medicines). In multivariable models that included characteristics of the mothers and of the nurse-midwives, the rate of delivering the essential childbirth practices was 1.71 times greater in the follow-up compared to baseline (95% CI 1.61-1.81). CONCLUSION Implementation of SCC has the potential to improve essential childbirth practice in resource-poor settings like Bangladesh. This study emphasizes the need for health system strengthening in order to achieve the full advantages of SCC implementation.
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Affiliation(s)
- Herfina Y Nababan
- Centre for Universal Health Coverage, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh.
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, the University of Melbourne, 333 Exhibition Street, Melbourne, Victoria, 3004, Australia.
| | - Rubana Islam
- Centre for Universal Health Coverage, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh
- School of Public Health & Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Shabnam Mostari
- James P. Grant School of Public Health, BRAC University, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Md Tariqujjaman
- Centre for Universal Health Coverage, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Malabika Sarker
- James P. Grant School of Public Health, BRAC University, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Mohammad Tajul Islam
- Japan International Cooperation Agency (JICA), 3rd Floor, Bay's Galleria, 57 Gulshan Avenue (CWS-A19), Gulshan-1, Dhaka, 1212, Bangladesh
| | - Corrina Moucheraud
- Department of Health Policy and Management, UCLA Fielding School of Public Health, 650 Charles E Young Dr S, Los Angeles, CA, 90095, USA
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Bonet M, Ota E, Chibueze CE, Oladapo OT. Routine antibiotic prophylaxis after normal vaginal birth for reducing maternal infectious morbidity. Cochrane Database Syst Rev 2017; 11:CD012137. [PMID: 29190037 PMCID: PMC6486135 DOI: 10.1002/14651858.cd012137.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Infectious morbidities contribute to considerable maternal and perinatal morbidity and mortality, including women at no apparent increased risk of infection. To reduce the incidence of infections, antibiotics are often administered to women after uncomplicated childbirth, particularly in settings where women are at higher risk of puerperal infectious morbidities. OBJECTIVES To assess whether routine administration of prophylactic antibiotics to women after normal (uncomplicated) vaginal birth, compared with placebo or no antibiotic prophylaxis, reduces postpartum maternal infectious morbidities and improves outcomes. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 August 2017), LILACS, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (22 August 2017) and reference lists of retrieved studies. SELECTION CRITERIA We planned to include randomised or quasi-randomised trials evaluating the use of prophylactic antibiotics versus placebo or no antibiotic prophylaxis. Trials using a cluster-randomised design would have been eligible for inclusion, but we found none.In future updates of this review, we will include studies published in abstract form only, provided sufficient information is available to assess risks of bias. We will consider excluded abstracts for inclusion once the full publication is available, or the authors provide more information.Trials using a cross-over design are not eligible for inclusion in this review. DATA COLLECTION AND ANALYSIS Two review authors conducted independent assessment of trials for inclusion and risks of bias. They independently extracted data and checked them for accuracy, resolving differences in assessments by discussion. They evaluated methodological quality using standard Cochrane criteria and the GRADE approach.We present the summaries as risk ratios (RRs) and mean difference (MDs) using fixed- or random-effect models. For one primary outcome we found considerable heterogeneity and interaction. We explored further using subgroup analysis to investigate the effects of the randomisation unit. All review authors discussed and interpreted the results. MAIN RESULTS One randomised controlled trial (RCT) and two quasi-RCTs contributed data on 1779 women who had uncomplicated vaginal births, comparing different antibiotic regimens with placebo or no treatment. The included trials took place in the 1960s (one trial) and 1990s (two trials). The trials were conducted in France, the USA and Brazil. Antibiotics administered included: oral sulphamethoxypyridazine or chloramphenicol for three to five days, and intravenous amoxicillin and clavulanic acid in a single dose one hour after birth. We rated most of the domains for risk of bias as high risk, with the exception of reporting bias and other potential bias.The quality of evidence ranged from low to very low, based on the GRADE quality assessment, given very serious design limitations of the included studies, few events and wide confidence intervals (CIs) of effect estimates.We found a decrease in the risk of endometritis (RR 0.28, 95% CI 0.09 to 0.83, two trials, 1364 women,very low quality). However, one trial reported zero events for this outcome and we rate the evidence as very low quality. There was little or no difference between groups for the risk of urinary tract infection (RR 0.25, 95% CI 0.05 to 1.19, two trials, 1706 women,low quality), wound infection after episiotomy (reported as wound dehiscence in the included trials) (RR 0.78, 95% CI 0.31 to 1.96, two trials, 1364 women, very low quality) and length of maternal hospital stay in days (MD -0.15, 95% CI -0.31 to 0.01, one trial, 1291 women, very low quality). Cost of care in US dollar equivalent was 2½ times higher in the control group compared to the group receiving antibiotics prophylaxis (USD 3600: USD 9000, one trial, 1291 women). There were few or no differences between treated and control groups for adverse effects of antibiotics (skin rash) reported in one woman in each of the two trials (RR 3.03, 95% CI 0.32 to 28.95, two trials, 1706 women, very low quality). The incidence of severe maternal infectious morbidity, antimicrobial resistance or women's satisfaction with care were not addressed by any of the included studies. AUTHORS' CONCLUSIONS Routine administration of antibiotics may reduce the risk of endometritis after uncomplicated vaginal birth. The small number and nature of the trials limit the interpretation of the evidence for application in practice, particularly in settings where women may be at higher risk of developing endometritis. The use of antibiotics did not reduce the incidence of urinary tract infections, wound infection or the length of maternal hospital stay. Antibiotics are not a substitute for infection prevention and control measures around the time of childbirth and the postpartum period. The decision to routinely administer prophylactic antibiotics after normal vaginal births needs to be balanced by patient features, childbirth setting and provider experience, including considerations of the contribution of indiscriminate use of antibiotics to raising antimicrobial resistance. Well-designed and high-powered randomised controlled trials would help to evaluate the added value of routine antibiotic administration as a measure to prevent maternal infections after normal vaginal delivery.
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Affiliation(s)
- Mercedes Bonet
- World Health OrganizationUNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and ResearchAvenue Appia 20GenevaSwitzerlandCH‐1211
| | - Erika Ota
- St. Luke's International University, Graduate School of Nursing SciencesGlobal Health Nursing10‐1 Akashi‐choChuo‐KuTokyoJapan104‐0044
| | - Chioma E Chibueze
- National Center for Child Health and DevelopmentDepartment of Health Policy2‐10‐1 Okura, Setagaya‐kuTokyoJapan157‐8535
| | - Olufemi T Oladapo
- World Health OrganizationUNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and ResearchAvenue Appia 20GenevaSwitzerlandCH‐1211
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Bonet M, Ota E, Chibueze CE, Oladapo OT. Antibiotic prophylaxis for episiotomy repair following vaginal birth. Cochrane Database Syst Rev 2017; 11:CD012136. [PMID: 29096053 PMCID: PMC6485970 DOI: 10.1002/14651858.cd012136.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Bacterial infections occurring during labour, childbirth, and the puerperium may be associated with considerable maternal and perinatal morbidity and mortality. Antibiotic prophylaxis might reduce wound infection incidence after an episiotomy, particularly in situations associated with a higher risk of postpartum perineal infection, such as midline episiotomy, extension of the incision, or in settings where the baseline risk of infection after vaginal birth is high. However, available evidence is unclear concerning the role of prophylactic antibiotics in preventing infections after an episiotomy. OBJECTIVES To assess whether routine antibiotic prophylaxis before or immediately after incision or repair of episiotomy for women with an uncomplicated vaginal birth, compared with either placebo or no antibiotic prophylaxis, prevents maternal infectious morbidities and improves outcomes. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth's Trials Register, LILACS, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP) on 24 July 2017, and screened reference lists of retrieved studies. SELECTION CRITERIA We considered randomised controlled trials, quasi-randomised trials, and cluster-randomised trials that compared the use of routine antibiotic prophylaxis for incision or repair of an episiotomy for women with otherwise normal vaginal births, compared with either placebo or no antibiotic prophylaxis. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data, and checked them for accuracy. We only found one quasi-randomised trial that met the inclusion criteria and was included in the analysis, therefore, we did not perform a meta-analysis. MAIN RESULTS We included one quasi-RCT (with data from 73 women) in the review. The trial, which was conducted in a public hospital in Brazil, compared oral chloramphenicol 500 mg four times daily for 72 hours after episiotomy repair (N = 34) and no treatment (N = 39). We assessed most of the domains at high risk of bias because women were randomised according to even and odd numbers, allocation concealment was based on protocol number, there was no treatment or placebo administered in the control group, we were unclear about the blinding of outcome assessments, and outcomes were incompletely reported. We considered the other domains to be at low risk of bias. We downgraded the quality of the evidence for very serious design limitations (related to lack of random sequence generation, allocation concealment, and blinding) and imprecision of effect estimates (small sample sizes and wide confidence intervals (CI) of effect estimates).We found very low-quality evidence, from one trial of 73 women, that there was no clear indication that prophylactic antibiotics reduced the incidence of episiotomy wound dehiscence with infection (risk ratio (RR) 0.13, 95% CI 0.01 to 2.28), or without infection (RR 0.82, 95% CI 0.29 to 2.34). No cases of other puerperal infections (e.g. endometritis) were reported in either the antibiotic or control group.The trial did not report on any of the secondary outcomes of interest for this review, including severe maternal infectious morbidity, discomfort or pain at the episiotomy wound site, sexual function postpartum, adverse effects of antibiotics, costs of care, women's satisfaction with care, and individual antimicrobial resistance. AUTHORS' CONCLUSIONS There was insufficient evidence to assess the clinical benefits or harms of routine antibiotic prophylaxis for episiotomy repair after normal birth. The only trial included in this review had several methodological limitations, with very serious limitations in design, and imprecision of effect estimates. In addition, the trial tested an antibiotic with limited application in current clinical practice. There is a need for a careful and rigorous assessment of the comparative benefits and harms of prophylactic antibiotics on infection morbidity after episiotomy, in well-designed randomised controlled trials, using common antibiotics and regimens in current obstetric practice.
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Affiliation(s)
- Mercedes Bonet
- World Health OrganizationUNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and ResearchAvenue Appia 20GenevaSwitzerlandCH‐1211
| | - Erika Ota
- St. Luke's International University, Graduate School of Nursing SciencesGlobal Health Nursing10‐1 Akashi‐choChuo‐KuTokyoJapan104‐0044
| | - Chioma E Chibueze
- National Center for Child Health and DevelopmentDepartment of Health Policy2‐10‐1 Okura, Setagaya‐kuTokyoJapan157‐8535
| | - Olufemi T Oladapo
- World Health OrganizationUNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and ResearchAvenue Appia 20GenevaSwitzerlandCH‐1211
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