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E A, S N, Subramanian A, T T, Vellapandian C, J N. A Comprehensive Case Report Emphasizing the Role of Caesarean Section, Antibiotic Prophylaxis, and Post-operative Care in Meconium-Stained Fetal Distress Syndrome. Cureus 2024; 16:e66123. [PMID: 39229399 PMCID: PMC11370710 DOI: 10.7759/cureus.66123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Accepted: 08/04/2024] [Indexed: 09/05/2024] Open
Abstract
Meconium-stained amniotic fluid (MSAF) presents a complex medical scenario with significant implications for maternal and neonatal health. This case report explores the intricacies surrounding MSAF, focusing on its diagnosis, treatment, and the associated meconium aspiration syndrome (MAS). The report emphasizes the critical role of antibiotic prophylaxis in lower segment cesarean sections (LSCS) in balancing infection prevention in the mother with neonatal considerations. Additionally, it highlights personalized pain management and post-operative care regimens, contributing to a comprehensive strategy for maternal and neonatal well-being. A 27-year-old primigravida (primi) underwent a cesarean section due to the presence of meconium in the amniotic fluid, indicating fetal distress. The report meticulously documents vital signs, laboratory findings, and the timeline of events. The case report underscores the importance of diagnosing and treating MAS, offering valuable insights into management strategies and their impact on maternal and neonatal health. This case report emphasizes the critical role of antibiotic prophylaxis in LSCS to prevent maternal infection while considering neonatal well-being. The personalized pain management approach and post-operative care regimens contribute significantly to a comprehensive strategy for maternal and neonatal well-being. The findings provide valuable insights into diagnosing and treating MAS, highlighting the importance of timely intervention in similar clinical scenarios.
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Affiliation(s)
- Arun E
- Pharmacology and Therapeutics, SRM College of Pharmacy, SRM Institute of Science and Technology, Chennai, IND
| | - Nirenjen S
- Pharmacology, SRM College of Pharmacy, SRM Institute of Science and Technology, Chennai, IND
| | - Arunkumar Subramanian
- Pharmacology, SRM College of Pharmacy, SRM Institute of Science and Technology, Chennai, IND
| | - Tamilanban T
- Pharmacology, SRM College of Pharmacy, SRM Institute of Science and Technology, Chennai, IND
| | - Chitra Vellapandian
- Pharmacology, SRM College of Pharmacy, SRM Institute of Science and Technology, Chennai, IND
| | - Narayanan J
- Pharmacy/Pharmacology, SRM College of Pharmacy, SRM Institute of Science and Technology, Chennai, IND
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Young N, Quinlivan J, Fox R, Anderson J, Davis L, Mooney SS. Economic cost of secondary postpartum haemorrhage: A case-control study at a tertiary hospital in Australia. Aust N Z J Obstet Gynaecol 2023. [PMID: 36944552 DOI: 10.1111/ajo.13664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 02/18/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Secondary postpartum haemorrhage (PPH) is a condition which affects 0.2-3.0% of women. Despite its impact on maternal morbidity, there is a lack of understanding of the cost burden of disease. AIMS To determine the economic cost of secondary PPH in the postpartum period, compared to the costs for women without this diagnosis. MATERIALS AND METHODS Data were prospectively collected on a cohort of 97 women who presented with secondary PPH to the emergency department (ED) between July 2020 and February 2021. A case-control design was then used to compare postpartum cost data from these patients to a group of 97 controls who were matched to maternal demographics, and who did not present with secondary PPH. RESULTS For women with secondary PPH, there were significantly more hospital attendances, and postpartum costs were higher for all cost subcategories across ED, admissions, and outpatient attendances (P < 0.0001), compared to controls. The total cost of postpartum care for 97 patients with secondary PPH was $254 377.62 with an average cost per patient of $2622.45, compared to $26 670.46 for 97 controls with an average cost of $274.95 per patient (P < 0.0001). This demonstrates a 9.5-fold increase in postpartum costs per woman with secondary PPH. CONCLUSIONS Secondary PPH is an under-researched condition which presents a significant cost burden for the health system. Evidence-based guidelines addressing the prevention and management of secondary PPH may assist in minimising this cost burden for both the health service and the patient.
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Affiliation(s)
- Nicole Young
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Julie Quinlivan
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Rachael Fox
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Jess Anderson
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Laura Davis
- Department of Obstetrics and Gynaecology, Northeast Health, Wangaratta, Victoria, Australia
| | - Samantha S Mooney
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
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Mbuyamba HT, Muamba CM, Binene SK, Uwonda SA. Evaluation of the practice of surgical antibiotic prophylaxis in a Zonal Referral Hospital in Mbujimayi, Democratic Republic of the Congo (DRC). BMC Surg 2023; 23:28. [PMID: 36739370 PMCID: PMC9899390 DOI: 10.1186/s12893-023-01926-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Surgical Antibiotic Prophylaxis (SAP) is helpful in preventing patients from developing Surgical Site Infections (SSI). In Mbujimayi, the documentation on the practice of SAP is outdated and inadequate. The last study was conducted more than 5 years ago. This study aims at assessing the compliance of the practice of antibiotic prophylaxis in the surgical and obstetrics-gynecology departments of the Bonzola Zonal Referral Hospital (BZRH) compared to the international standards. METHODS A prospective observational study was conducted from March 2020 to March 2021 involving 324 surgical patients who received antibiotic prophylaxis. Interventions were assessed as "compliant" if all the variables individually complied with the criteria for antibiotic prophylaxis use. RESULTS Three hundred and twenty-four patients were enrolled in this study. Compliance was found to be 87.35% for the indication for administration; 0.31% for the choice of the molecule; 3.65% for the time of the first administration; none for the duration of antibiotic prophylaxis. Therefore, the overall compliance was nil. This study shows a significant gap when the current practice in Mbujimayi town is compared to the recommendations of international societies. CONCLUSION SAP is often indicated in accordance with international recommendations in Mbujimayi. However, the choice of the molecule, the dosage, the time of first administration and the duration of SAP deviate from them. Thus, the compliance of SAP is nil.
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Affiliation(s)
- Hervé Tshikomba Mbuyamba
- Department of Surgery, Université Officielle de Mbujimayi (UOM), Mbujimayi, Democratic Republic of the Congo ,grid.25867.3e0000 0001 1481 7466Department of Surgery, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, United Republic of Tanzania
| | - Crispin Mukendi Muamba
- Department of Surgery, Université Officielle de Mbujimayi (UOM), Mbujimayi, Democratic Republic of the Congo ,Department of Surgery, Bonzola Zonal Referral Hospital, Mbujimayi, Democratic Republic of the Congo
| | - Séraphin Katulondi Binene
- Department of Surgery, Université Officielle de Mbujimayi (UOM), Mbujimayi, Democratic Republic of the Congo
| | - Séverin Akinja Uwonda
- Department of Surgery, Université Officielle de Mbujimayi (UOM), Mbujimayi, Democratic Republic of the Congo
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Odogwu NM. Role of short interpregnancy interval, birth mode, birth practices, and the postpartum vaginal microbiome in preterm birth. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 4:1082199. [PMID: 36685092 PMCID: PMC9845938 DOI: 10.3389/frph.2022.1082199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/06/2022] [Indexed: 01/05/2023] Open
Abstract
There have been widely documented beneficial role of vaginal Lactobacillus species as an important biomarker for vaginal health and healthy pregnancy progression. When translating this to clinical settings, pregnant women with low proportions of Lactobacillus and commensurately high proportion of rich and highly diverse abnormal microbiota are most likely to encounter negative pregnancy outcome such as preterm birth and postpartum complications. However, multiple literatures have also addressed this notion that the absence of a Lactobacillus-dominated microbiota does not appear to directly imply to a diseased condition and may not be a major determinant of negative obstetric outcome. Caesarian delivery is notably a risk factor for preterm birth and postpartum endometritis, yet recent data shows a trend in the overuse of CS across several populations. Growing evidence suggest the potential role of vaginal/uterine cleaning practice during CS procedures in influencing postpartum infections, however there is a controversy that this practice is associated with increased rates of postpartum endometritis. The preponderance of bacterial vaginosis associated bacteria vagitype at postpartum which persist for a long period of time even after lochia regression in some women may suggest why short interpregnancy interval may pose a potential risk for preterm birth, especially multigravidas. While specifically linking a community of microbes in the female reproductive tract or an exact causative infectious agent to preterm birth and postpartum pathologies remains elusive, clinical attention should also be drawn to the potential contribution of other factors such as short interpregnancy interval, birth mode, birth practices and the postpartum vaginal microbiome in preterm birth which is explicitly described in this narrative review.
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Affiliation(s)
- Nkechi Martina Odogwu
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States,School of Public Health, University of Minnesota, Minneapolis, MN, United States,Correspondence: Nkechi Martina Odogwu ,
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Kuhr K, Axelsson PB, Andersen BR, Ammitzbøll ILA, Clausen TD, Løkkegaard ECL. Postoperative infections after non-elective cesarean section - a retrospective cohort study of prevalence and risk factors at a single center in Denmark administering prophylactic antibiotics after cord clamping. BMC Pregnancy Childbirth 2022; 22:945. [PMID: 36528589 PMCID: PMC9758935 DOI: 10.1186/s12884-022-05300-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Mothers giving birth by non-elective cesarean section have considerably higher risk of developing postoperative infection, than mothers giving birth by elective cesarean section. Meta-analyses have shown that the risk of infection is reduced when administering antibiotics at least 30 min prior to skin incision rather than after cord clamping. If given prior to incision, antibiotics are present in the neonatal bloodstream for up to 24 h after delivery, with early exposure to antibiotics potentially disturbing development of the gut microbiome. We aimed to retrospectively assess the prevalence of postoperative infection after non-elective cesarean section at a single labor ward administering antibiotics after cord clamping, additionally investigating risk factors for developing postoperative infections. METHODS In this retrospective cohort study, we included a total of 2,725 women giving birth by non-elective cesarean section in 2010-2017 with a review of records for prenatal risk factors, labor management, and perinatal outcomes. The primary outcomes were a main composite infection of development of either endometritis, surgical-site infection, or sepsis in conjunction with a relevant antibiotic prescription. Secondary outcomes included infection of unknown focus, mastitis, urinary tract infection, and pneumonia. RESULTS A total of 88 patients developed a main composite infection (3.2%). These infections subdivide into endometritis (n = 37/2725, 1.4%), surgical-site infection (n = 35/2725, 1.3%) and sepsis (n = 15/2725, 0.6%). We found a high body mass index (aOR = 3.38, 95%CI 1.93-5.92) and intrapartum fever (aOR = 2.26, 95%CI 1.22-4.59) to be independent risk-factors for developing postoperative infection after non-elective cesarean section. Furthermore, we found delivery by a more expedient emergency grade 2 cesarean section (aOR = 0.61 95%CI 0.37-0.998) compared to grade 3 to be a protective factor for developing postoperative infection after non-elective cesarean section. CONCLUSION In a labor ward administering antibiotics after cord clamping at non-elective cesarean births, we find a low prevalence of main composite infections when compared to estimates from meta-analyses on the topic. We conclude that administration of prophylactic antibiotics after cord clamping appears to result in acceptable rates of postoperative infection and avoids transplacental-transmission of antibiotics to the infant.
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Affiliation(s)
- Katja Kuhr
- grid.414092.a0000 0004 0626 2116Department of Obstetrics and Gynaecology, Nordsjaellands Hospital Hillerød, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Paul Bryde Axelsson
- grid.414092.a0000 0004 0626 2116Department of Obstetrics and Gynaecology, Nordsjaellands Hospital Hillerød, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Betina Ristorp Andersen
- grid.414092.a0000 0004 0626 2116Department of Obstetrics and Gynaecology, Nordsjaellands Hospital Hillerød, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Ida Lise Arevad Ammitzbøll
- grid.414092.a0000 0004 0626 2116Department of Obstetrics and Gynaecology, Nordsjaellands Hospital Hillerød, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Tine Dalsgaard Clausen
- grid.414092.a0000 0004 0626 2116Department of Obstetrics and Gynaecology, Nordsjaellands Hospital Hillerød, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Ellen Christine Leth Løkkegaard
- grid.414092.a0000 0004 0626 2116Department of Obstetrics and Gynaecology, Nordsjaellands Hospital Hillerød, Dyrehavevej 29, 3400 Hillerød, Denmark
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Abdel-Latif AM, Moharram AA, Higazy A, Ghoneim NI, Shafei O, Abdelhady SG, Assal G, Ibrahim A. Incidence and perioperative risk factors for surgical site infections in neurosurgery: prospective observational study. EGYPTIAN JOURNAL OF NEUROSURGERY 2022. [DOI: 10.1186/s41984-021-00142-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Surgical site infections (SSI) represent a burden on the health care system especially in developing countries with significant morbidity and mortality. In Egypt, especially in our institution, there is no registry for the SSI rate or the contributing factors with no clear guidelines regarding the regimen of perioperative antibiotic prophylaxis. Our study was conducted to assess the local practice and to calculate the rate and risk factors of SSI.
Patients and methods
A prospective registry was established at the Neurosurgery Department, Demerdash teaching hospital Ain Shams University, Cairo, Egypt. All patients who underwent elective neurosurgical procedures were included in this study. Trauma patients were excluded. Patients were followed-up for incident SSI for 1 month postoperatively. SSIs were identified based on CDC criteria and a standardized data collection form predictor variables including patient characteristics, preoperative, intraoperative, and postoperative factors along with the pattern of antimicrobial prophylaxis.
Results
The study included 248 patients with 1-month postoperative follow-up. An SSI rate of 19% was recorded being mainly in patients below 10 years of age. Postoperative CSF leak was noticed to be the most significant risk factor of SSI in our study (p value < 0.01). Sixty five percent of culture results showed infection with gram-negative bacilli with the predominance of Acinetobacter.
Conclusion
Prolonged use of perioperative antibiotics does not seem to have an added benefit in SSI prevention. Tailoring of the used antibiotic regimen is highly recommended according to the latest antimicrobial prophylaxis guidelines and the local culture and sensitivity results.
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Providing education and tools increases nurses’ and midwives’ assessment for puerperal sepsis in a regional referral hospital in South Western Uganda. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2022. [DOI: 10.1016/j.ijans.2022.100487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Igwemadu GT, Eleje GU, Eno EE, Akunaeziri UA, Afolabi FA, Alao AI, Ochima O. Single-dose versus multiple-dose antibiotics prophylaxis for preventing caesarean section postpartum infections: A randomized controlled trial. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221101071. [PMID: 35670414 PMCID: PMC9178729 DOI: 10.1177/17455057221101071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 04/16/2022] [Accepted: 04/28/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Caesarean section, a common obstetric surgical procedure, is a major predisposing factor for puerperal infections, requiring the need for antibiotic prophylaxis. Evidence suggests that single-dose antibiotic prophylaxis has comparable efficacy to multiple-dose antibiotic prophylaxis, but with a lower cost and risk of antibiotic resistance. However, single-dose antibiotic prophylaxis after caesarean section is not generally used in many centres in sub-Saharan Africa. OBJECTIVE This study aimed to compare the effectiveness of single- versus multiple-dose antibiotic prophylaxis to prevent post-caesarean section infections. METHODOLOGY This open-label, randomized controlled trial involved 162 consenting patients admitted for caesarean section (elective or emergency) at the Federal Medical Centre Keffi. They were distributed randomly into treatment arm A or B. Subjects in both arms received intravenous ceftriaxone (1 g) and metronidazole (500 mg) 30-60 min before incision; subjects in arm B received additional parenteral doses for 48 h and then cefuroxime 500 mg tablets every 12 h and metronidazole 400 mg tablets every 8 h for 5 days. The patients were monitored for 2 weeks for evidence of wound infection, febrile morbidity and clinical endometritis. RESULT There was no statistical difference in the incidence of wound infection (6.6% versus 7.4%; p = .882) and febrile morbidity (11.8% versus 11.1%, p = .807). However, clinical endometritis (0.0% versus 6.1%, p = .028) was statistically significant with none reported in the single-dose arm. CONCLUSION Single-dose ceftriaxone and metronidazole is as effective as multiple doses for antibiotic prophylaxis to prevent post-caesarean section infections. Adoption of this approach in low-risk patients would reduce the cost of prophylactic antibiotics, workload for staff and antibiotic resistance.
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Affiliation(s)
| | - George Uchenna Eleje
- Effective Care Research Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine, Nnamdi Azikiwe University, Awka, Nigeria
| | - Enang Enang Eno
- Department of Obstetrics and Gynaecology, Federal Medical Centre, Keffi, Nigeria
| | | | | | - Abayomi Ibukun Alao
- Department of Obstetrics and Gynaecology, Federal Medical Centre, Keffi, Nigeria
| | - Onazi Ochima
- Department of Obstetrics and Gynaecology, Federal Medical Centre, Keffi, Nigeria
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Ernest EC, Hellar A, Varallo J, Tibyehabwa L, Bertram MM, Fitzgerald L, Katoto A, Mshana S, Simba D, Gwitaba K, Boddu R, Alidina S, Giiti G, Kihunrwa A, Balandya B, Urassa D, Hussein Y, Damien C, Wackenreuter B, Barash D, Morrison M, Reynolds C, Christensen A, Makuwani A. Reducing surgical site infections and mortality among obstetric surgical patients in Tanzania: a pre-evaluation and postevaluation of a multicomponent safe surgery intervention. BMJ Glob Health 2021; 6:e006788. [PMID: 34876458 PMCID: PMC8655579 DOI: 10.1136/bmjgh-2021-006788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/01/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Despite ongoing maternal health interventions, maternal deaths in Tanzania remain high. One of the main causes of maternal mortality includes postoperative infections. Surgical site infection (SSI) rates are higher in low/middle-income countries (LMICs), such as Tanzania, compared with high-income countries. We evaluated the impact of a multicomponent safe surgery intervention in Tanzania, hypothesising it would (1) increase adherence to safety practices, such as the WHO Surgical Safety Checklist (SSC), (2) reduce SSI rates following caesarean section (CS) and (3) reduce CS-related perioperative mortality rates (POMRs). METHODS We conducted a pre-cross-sectional/post-cross-sectional study design to evaluate WHO SSC utilisation, SSI rates and CS-related POMR before and 18 months after implementation. Our interventions included training of inter-professional surgical teams, promoting use of the WHO SSC and introducing an infection prevention (IP) bundle for all CS patients. We assessed use of WHO SSC and SSI rates through random sampling of 279 individual CS patient files. We reviewed registers and ward round reports to obtain the number of CS performed and CS-related deaths. We compared proportions of individuals with a characteristic of interest during pre-implementation and post implementation using the two-proportion z-test at p≤0.05 using STATA V.15. RESULTS The SSC utilisation rate for CS increased from 3.7% (5 out of 136) to 95.1% (136 out of 143) with p<0.001. Likewise, the proportion of women with SSI after CS reduced from 14% during baseline to 1% (p=0.002). The change in SSI rate after the implementation of the safe surgery interventions is statistically significant (p<0.001). The CS-related POMR decreased by 38.5% (p=0.6) after the implementation of safe surgery interventions. CONCLUSION Our findings show that our intervention led to improved utilisation of the WHO SSC, reduced SSIs and a drop in CS-related POMR. We recommend replication of the interventions in other LMICs.
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Affiliation(s)
| | | | | | | | | | | | - Adam Katoto
- JHPIEGO, Dar es Salaam, Tanzania, United Republic of
| | - Stella Mshana
- JHPIEGO, Dar es Salaam, Tanzania, United Republic of
| | - Dorcas Simba
- JHPIEGO, Dar es Salaam, Tanzania, United Republic of
| | | | - Rohini Boddu
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Shehnaz Alidina
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Geofrey Giiti
- Department of Surgery, Catholic University of Health and Allied Sciences Bugando, Mwanza, Tanzania, United Republic of
| | - Albert Kihunrwa
- Department of Obstetrics and Gynaecology, Bugando Medical Centre, Mwanza, Tanzania, United Republic of
| | - Belinda Balandya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - David Urassa
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Yahya Hussein
- President Office Regional Authority and Local Government, Dar es Salaam, Tanzania, United Republic of
| | - Caroline Damien
- Ministry of Health Community Development Gender Elderly and Children, Dar es Salaam, Tanzania, United Republic of
| | | | - David Barash
- Developing Health Globally, GE Foundation, Fairfield, Connecticut, USA
| | - Melissa Morrison
- The ELMA Philanthropies Services (U.S.), New York, New York, USA
| | | | | | - Ahmed Makuwani
- Ministry of Health Community Development Gender Elderly and Children, Dar es Salaam, Tanzania, United Republic of
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Hyldig N, Vinter CA, Lamont RF, Joergensen JS, Möller S. Response to prophylactic negative pressure wound dressing after caesarean section: an extended debate to include surgical aspects. BJOG 2021; 129:510-511. [PMID: 34590415 DOI: 10.1111/1471-0528.16908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Nana Hyldig
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Christina Anne Vinter
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Ronald F Lamont
- School of Life and Medical Sciences, University College London, London, UK
| | - Jan Stener Joergensen
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
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Williams MJ, Carvalho Ribeiro do Valle C, Gyte GM. Different classes of antibiotics given to women routinely for preventing infection at caesarean section. Cochrane Database Syst Rev 2021; 3:CD008726. [PMID: 33661539 PMCID: PMC8092483 DOI: 10.1002/14651858.cd008726.pub3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Caesarean section increases the risk of postpartum infection for women and prophylactic antibiotics have been shown to reduce the incidence; however, there are adverse effects. It is important to identify the most effective class of antibiotics to use and those with the least adverse effects. OBJECTIVES: To determine, from the best available evidence, the balance of benefits and harms between different classes of antibiotic given prophylactically to women undergoing caesarean section, considering their effectiveness in reducing infectious complications for women and adverse effects on both mother and infant. SEARCH METHODS For this 2020 update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (2 December 2019), and reference lists of retrieved studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing different classes of prophylactic antibiotics given to women undergoing caesarean section. RCTs published in abstract form were also included. We excluded trials that compared drugs with placebo or drugs within a specific class; these are assessed in other Cochrane Reviews. We excluded quasi-RCTs and cross-over trials. Cluster-RCTs were eligible for inclusion but none were identified. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included 39 studies, with 33 providing data (8073 women). Thirty-two studies (7690 women) contributing data administered antibiotics systemically, while one study (383 women) used lavage and was analysed separately. We identified three main comparisons that addressed clinically important questions on antibiotics at caesarean section (all systemic administration), but we only found studies for one comparison, 'antistaphylococcal cephalosporins (1st and 2nd generation) versus broad spectrum penicillins plus betalactamase inhibitors'. We found no studies for the following comparisons: 'antistaphylococcal cephalosporins (1st and 2nd generation) versus lincosamides' and 'antistaphylococcal cephalosporins (1st and 2nd generation) versus lincosamides plus aminoglycosides'. Twenty-seven studies (22 provided data) included comparisons of cephalosporins (only) versus penicillins (only). However for this update, we only pooled data relating to different sub-classes of penicillins and cephalosporins where they are known to have similar spectra of action against agents likely to cause infection at caesarean section. Eight trials, providing data on 1540 women, reported on our main comparison, 'antistaphylococcal cephalosporins (1st and 2nd generation) versus broad spectrum penicillins plus betalactamase inhibitors'. We found data on four other comparisons of cephalosporins (only) versus penicillins (only) using systemic administration: antistaphylococcal cephalosporins (1st and 2nd generation) versus non-antistaphylococcal penicillins (natural and broad spectrum) (9 studies, 3093 women); minimally antistaphylococcal cephalosporins (3rd generation) versus non-antistaphylococcal penicillins (natural and broad spectrum) (4 studies, 854 women); minimally antistaphylococcal cephalosporins (3rd generation) versus broad spectrum penicillins plus betalactamase inhibitors (2 studies, 865 women); and minimally antistaphylococcal cephalosporins (3rd generation) versus broad spectrum and antistaphylococcal penicillins (1 study, 200 women). For other comparisons of different classes of antibiotics, only a small number of trials provided data for each comparison, and in all but one case data were not pooled. For all comparisons, there was a lack of good quality data and important outcomes often included few women. Three of the studies that contributed data were undertaken with drug company funding, one was funded by the hospital, and for all other studies the funding source was not reported. Most of the studies were at unclear risk of selection bias, reporting bias and other biases, partly due to the inclusion of many older trials where trial reports did not provide sufficient methodological information. We undertook GRADE assessment on the only main comparison reported by the included studies, antistaphylococcal cephalosporins (1st and 2nd generation) versus broad spectrum penicillins plus betalactamase inhibitors, and the certainty ranged from low to very low, mostly due to concerns about risk of bias, wide confidence intervals (CI), and few events. In terms of the primary outcomes for our main comparison of 'antistaphylococcal cephalosporins (1st and 2nd generation) versus broad spectrum penicillins plus betalactamase inhibitors': only one small study reported sepsis, and there were too few events to identify clear differences between the drugs (risk ratio (RR) 2.37, 95% CI 0.10 to 56.41, 1 study, 75 women, very low-certainty evidence). There may be little or no difference between these antibiotics in preventing endometritis (RR 1.10; 95% CI 0.76 to 1.60, 7 studies, 1161 women; low-certainty evidence). None of the included studies reported on infant sepsis or infant oral thrush. For our secondary outcomes, we found there may be little or no difference between interventions for maternal fever (RR 1.07, 95% CI 0.65 to 1.75, 3 studies, 678 women; low-certainty evidence). We are uncertain of the effects on maternal: wound infection (RR 0.78, 95% CI 0.32 to 1.90, 4 studies, 543 women), urinary tract infection (average RR 0.64, 95% CI 0.11 to 3.73, 4 studies, 496 women), composite adverse effects (RR 0.96, 95% CI 0.09 to 10.50, 2 studies, 468 women), and skin rash (RR 1.08, 95% CI 0.28 to 4.1, 3 studies, 591 women) (all very low certainty evidence). Although maternal allergic reactions were reported by two studies, there were no events. There were no infant outcomes reported in the included studies. For the other comparisons, the results for most outcomes had wide CIs, few studies and few women included. None of the included trials reported on longer-term maternal outcomes, or on any infant outcomes. AUTHORS' CONCLUSIONS Based on the best currently available evidence, 'antistaphylococcal cephalosporins' and 'broad spectrum penicillins plus betalactamase inhibitors' may have similar efficacy at caesarean section when considering immediate postoperative infection, although we did not have clear evidence for several important outcomes. Most trials administered antibiotics at or after cord clamping, or post-operatively, so results may have limited applicability to current practice which generally favours administration prior to skin incision. We have no data on any infant outcomes, nor on late infections (up to 30 days) in the mother; these are important gaps in the evidence that warrant further research. Antimicrobial resistance is very important but more appropriately investigated by other trial designs.
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Affiliation(s)
- Myfanwy J Williams
- Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Carolina Carvalho Ribeiro do Valle
- Infection Prevention and Control, Hospital da Mulher Prof. Dr. José Aristodemo Pinotti - CAISM, Department of Obstetrics and Gynaecology, University of Campinas, Campinas, Brazil
| | - Gillian Ml Gyte
- Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
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Egan M, Dempsey E, Ryan CA, Ross RP, Stanton C. The Sporobiota of the Human Gut. Gut Microbes 2021; 13:1-17. [PMID: 33406976 PMCID: PMC7801112 DOI: 10.1080/19490976.2020.1863134] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/01/2020] [Accepted: 12/04/2020] [Indexed: 02/04/2023] Open
Abstract
The human gut microbiome is a diverse and complex ecosystem that plays a critical role in health and disease. The composition of the gut microbiome has been well studied across all stages of life. In recent years, studies have investigated the production of endospores by specific members of the gut microbiome. An endospore is a tough, dormant structure formed by members of the Firmicutes phylum, which allows for greater resistance to otherwise inhospitable conditions. This innate resistance has consequences for human health and disease, as well as in biotechnology. In particular, the formation of endospores is strongly linked to antibiotic resistance and the spread of antibiotic resistance genes, also known as the resistome. The term sporobiota has been used to define the spore-forming cohort of a microbial community. In this review, we present an overview of the current knowledge of the sporobiota in the human gut. We discuss the development of the sporobiota in the infant gut and the perinatal factors that may have an effect on vertical transmission from mother to infant. Finally, we examine the sporobiota of critically important food sources for the developing infant, breast milk and powdered infant formula.
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Affiliation(s)
- Muireann Egan
- Food Biosciences Department, Teagasc Food Research Centre, Moorepark, Fermoy, Co. Cork, Ireland
- APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Eugene Dempsey
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- Department of Neonatology, Cork University Maternity Hospital, Cork, Ireland
| | - C. Anthony Ryan
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- Department of Neonatology, Cork University Maternity Hospital, Cork, Ireland
| | - R. Paul Ross
- APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Catherine Stanton
- Food Biosciences Department, Teagasc Food Research Centre, Moorepark, Fermoy, Co. Cork, Ireland
- APC Microbiome Ireland, University College Cork, Cork, Ireland
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Wang T, Udomkittivorakul N, Bonfield M, Nadeem A, Gray J, Deshmukh H. Early life antibiotic exposure and host health: Role of the microbiota-immune interaction. Semin Perinatol 2020; 44:151323. [PMID: 33187735 DOI: 10.1016/j.semperi.2020.151323] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The neonatal population is at high risk for infections secondary to a unique, developing immune system. While a multitude of factors direct the development of the immune system, the role of environmental exposures on the microbiota may play a critical and potentially modifiable role. Recent evidence suggests that the disruption of the microbiota through the use of antibiotics not only leads to an immediately increased risk for neonatal complications but also long-term health issues related to autoimmune and inflammatory diseases. The exact cellular and molecular mechanisms behind these associations between the microbiota and neonatal outcomes are still under investigation. This review will examine the mechanistic interactions between the microbiota and the immune system, particularly in early life, along with how antibiotic mediated aberrations of the microbiome potentially lead to disease.
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Affiliation(s)
- Timothy Wang
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45219, USA.
| | - Natsumon Udomkittivorakul
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45219, USA
| | - Madeline Bonfield
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45219, USA; Immunology Graduate Program, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Amraha Nadeem
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45219, USA
| | - Jerilyn Gray
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45219, USA
| | - Hitesh Deshmukh
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45219, USA
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Mode of birth and risk of infection-related hospitalisation in childhood: A population cohort study of 7.17 million births from 4 high-income countries. PLoS Med 2020; 17:e1003429. [PMID: 33211696 PMCID: PMC7676705 DOI: 10.1371/journal.pmed.1003429] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 10/16/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The proportion of births via cesarean section (CS) varies worldwide and in many countries exceeds WHO-recommended rates. Long-term health outcomes for children born by CS are poorly understood, but limited data suggest that CS is associated with increased infection-related hospitalisation. We investigated the relationship between mode of birth and childhood infection-related hospitalisation in high-income countries with varying CS rates. METHODS AND FINDINGS We conducted a multicountry population-based cohort study of all recorded singleton live births from January 1, 1996 to December 31, 2015 using record-linked birth and hospitalisation data from Denmark, Scotland, England, and Australia (New South Wales and Western Australia). Birth years within the date range varied by site, but data were available from at least 2001 to 2010 for each site. Mode of birth was categorised as vaginal or CS (emergency/elective). Infection-related hospitalisations (overall and by clinical type) occurring after the birth-related discharge date were identified in children until 5 years of age by primary/secondary International Classification of Diseases, 10th Revision (ICD-10) diagnosis codes. Analysis used Cox regression models, adjusting for maternal factors, birth parameters, and socioeconomic status, with results pooled using meta-analysis. In total, 7,174,787 live recorded births were included. Of these, 1,681,966 (23%, range by jurisdiction 17%-29%) were by CS, of which 727,755 (43%, range 38%-57%) were elective. A total of 1,502,537 offspring (21%) had at least 1 infection-related hospitalisation. Compared to vaginally born children, risk of infection was greater among CS-born children (hazard ratio (HR) from random effects model, HR 1.10, 95% confidence interval (CI) 1.09-1.12, p < 0.001). The risk was higher following both elective (HR 1.13, 95% CI 1.12-1.13, p < 0.001) and emergency CS (HR 1.09, 95% CI 1.06-1.12, p < 0.001). Increased risks persisted to 5 years and were highest for respiratory, gastrointestinal, and viral infections. Findings were comparable in prespecified subanalyses of children born to mothers at low obstetric risk and unchanged in sensitivity analyses. Limitations include site-specific and longitudinal variations in clinical practice and in the definition and availability of some data. Data on postnatal factors were not available. CONCLUSIONS In this study, we observed a consistent association between birth by CS and infection-related hospitalisation in early childhood. Notwithstanding the limitations of observational data, the associations may reflect differences in early microbial exposure by mode of birth, which should be investigated by mechanistic studies. If our findings are confirmed, they could inform efforts to reduce elective CS rates that are not clinically indicated.
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Clindamycin, Gentamicin, and Risk of Clostridium difficile Infection and Acute Kidney Injury During Delivery Hospitalizations. Obstet Gynecol 2020; 135:59-67. [PMID: 31809424 DOI: 10.1097/aog.0000000000003568] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe risk of Clostridium difficile infection associated with clindamycin and acute kidney injury associated with gentamicin during delivery hospitalizations. METHODS Women admitted for delivery from January 2006 to March 2015 were analyzed using an inpatient administrative database. Primary outcomes were C difficile infection and acute kidney injury. C difficile infection was compared between women receiving clindamycin (with or without other antibiotics) and women receiving antibiotics other than clindamycin. Acute kidney injury was compared between women receiving gentamicin (with or without other antibiotics), women receiving antibiotics other than gentamicin, and women receiving no antibiotics. Unadjusted and adjusted log linear models analyzing the role of patient demographics, mode of delivery, and hospital-level characteristics were created evaluating risk of C difficile infection and acute kidney injury with risk ratios (RRs) and adjusted risk ratios with 99% CIs as measures of association. A sensitivity analysis for gentamicin and acute kidney injury was performed restricted to women with preeclampsia. RESULTS Of 5,657,523 women admitted for delivery hospitalization, 266,402 (4.7%) received clindamycin and 165,726 (2.9%) received gentamicin. C difficile infection was diagnosed in 0.04% of women receiving clindamycin. Compared with women receiving other antibiotics, clindamycin was associated with a nearly threefold increased risk of C difficile infection (RR 2.93, 99% CI 2.21-3.90). Acute kidney injury was diagnosed in 0.24% of women receiving gentamicin. Gentamicin was associated with a threefold increased risk of acute kidney injury (RR 3.01, 99% CI 2.62-3.45) compared with women receiving other antibiotics, whereas receipt of no antibiotics was associated with significantly lower risk (RR 0.18, 99% CI 0.15-0.20). In adjusted analyses, these associations retained significance. Significantly increased risk of acute kidney injury was noted for women with preeclampsia receiving gentamicin (RR 2.04, 99% CI 1.64-2.53). CONCLUSION Receipt of clindamycin was associated with significantly increased likelihood for C difficile infection and receipt of gentamicin with significantly increased likelihood of acute kidney injury, although the absolute risk of these complications was low.
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Martin C, Auboyer C, Boisson M, Dupont H, Gauzit R, Kitzis M, Leone M, Lepape A, Mimoz O, Montravers P, Pourriat JL. Antibioprophylaxie en chirurgie et médecine interventionnelle (patients adultes). Actualisation 2017. ANESTHÉSIE & RÉANIMATION 2019. [DOI: 10.1016/j.anrea.2019.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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17
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Winther A, Axelsson PB, Clausen TD, Løkkegaard E. Prophylactic antibiotics in caesarean delivery before or after cord clamping - protecting the mother at the expense of the infant's microbiota? BJOG 2019; 127:203-206. [PMID: 31544335 DOI: 10.1111/1471-0528.15960] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Acr Winther
- Department of Gynaecology and Obstetrics, North Zealand Hospital, University of Copenhagen, Hillerød, Denmark
| | - P B Axelsson
- Department of Gynaecology and Obstetrics, North Zealand Hospital, University of Copenhagen, Hillerød, Denmark
| | - T D Clausen
- Department of Gynaecology and Obstetrics, North Zealand Hospital, University of Copenhagen, Hillerød, Denmark
| | - Ecl Løkkegaard
- Department of Gynaecology and Obstetrics, North Zealand Hospital, University of Copenhagen, Hillerød, Denmark
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18
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Martin C, Auboyer C, Boisson M, Dupont H, Gauzit R, Kitzis M, Leone M, Lepape A, Mimoz O, Montravers P, Pourriat J. Antibioprophylaxis in surgery and interventional medicine (adult patients). Update 2017. Anaesth Crit Care Pain Med 2019; 38:549-562. [DOI: 10.1016/j.accpm.2019.02.017] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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19
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Moore RE, Townsend SD. Temporal development of the infant gut microbiome. Open Biol 2019; 9:190128. [PMID: 31506017 PMCID: PMC6769289 DOI: 10.1098/rsob.190128] [Citation(s) in RCA: 145] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 08/15/2019] [Indexed: 12/21/2022] Open
Abstract
The majority of organisms that inhabit the human body reside in the gut. Since babies are born with an immature immune system, they depend on a highly synchronized microbial colonization process to ensure the correct microbes are present for optimal immune function and development. In a balanced microbiome, symbiotic and commensal species outcompete pathogens for resources. They also provide a protective barrier against chemical signals and toxic metabolites. In this targeted review we will describe factors that influence the temporal development of the infant microbiome, including the mode of delivery and gestational age at birth, maternal and infant perinatal antibiotic infusions, and feeding method-breastfeeding versus formula feeding. We will close by discussing wider environmental pressures and early intimate contact, particularly between mother and child, as they play a pivotal role in early microbial acquisition and community succession in the infant.
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Affiliation(s)
| | - Steven D. Townsend
- Department of Chemistry, Vanderbilt University, Nashville, TN 37235, USA
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20
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Douville SE, Callaway LK, Amoako A, Roberts JA, Eley VA. Reducing post-caesarean delivery surgical site infections: a narrative review. Int J Obstet Anesth 2019; 42:76-86. [PMID: 31606251 DOI: 10.1016/j.ijoa.2019.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/22/2019] [Accepted: 08/28/2019] [Indexed: 01/15/2023]
Abstract
Surgical site infection complicates 1-10% of caesarean deliveries. With the rate of caesarean delivery increasing, it is important to identify effective measures of preventing surgical site infection and to consider their impact on maternal and neonatal outcomes. Compelling evidence supports the use of prophylactic antibiotics, prior to skin incision, to reduce surgical site infection. However, there remain international variations in terms of the recommended agent, dose and body weight-adjusted dosing. Advances in wound dressings are an evolving area of interest and surgical technique can influence outcomes. This narrative review explores pharmacological and non-pharmacological methods of preventing surgical site infection following caesarean delivery.
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Affiliation(s)
- S E Douville
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - L K Callaway
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia; Department of Obstetrics and Gynaecology/Obstetric Medicine, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - A Amoako
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia; Department of Obstetrics and Gynaecology/Obstetric Medicine, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - J A Roberts
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia; University of Queensland Centre for Clinical Research, The University of Queensland, Herston, Queensland, Australia; Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Herston, Queensland, Australia; Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France; Department of Pharmacy and Intensive Care Medicine, The Royal Brisbane and Women's Hospital, Herston, Qld, Australia
| | - V A Eley
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia; Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
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Alrammaal HH, Batchelor HK, Morris RK, Chong HP. Efficacy of perioperative cefuroxime as a prophylactic antibiotic in women requiring caesarean section: A systematic review. Eur J Obstet Gynecol Reprod Biol 2019; 242:71-78. [PMID: 31569027 DOI: 10.1016/j.ejogrb.2019.08.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/23/2019] [Accepted: 08/30/2019] [Indexed: 11/19/2022]
Abstract
Intravenous (IV) Cefuroxime (CFX) is widely used in Caesarean Section (CS) as a prophylactic antibiotic. The objective of this systematic review to compare CFX concentration in maternal blood and adipose tissue with the incidence of surgical site infection (SSI) following IV CFX in non-obese and obese women undergoing CS. A search in Medline, EMBASE, Cochrane, Web of Science, CINHAL Plus, Scopus and Google Scholar was conducted without language or date restrictions. Published articles or abstracts reporting CFX concentration or rates of SSI following CFX IV administration in adult women requiring CS were included. Studies were screened by title and abstract. Quality of studies was assessed via the ClinPK Statement checklist (Pharmacokinetics studies), or Joanna Briggs Institute Critical Appraisal Tools (SSI studies). The Cochrane Effective Practice and Organisation of Care checklist evaluated the risk of bias (SSI studies). There were no studies evaluating CFX concentrations in obese women undergoing CS. For non-obese women, CFX plasma concentrations ranged from 9.85 to 95.25 mg/L within 30-60 min of administration (1500 mg dose; 4 articles, n = 108 women). Plasma CFX concentrations were above the minimum inhibitory concentration (8 mg/L) for up to 3 h post-dose. No studies reported on CFX concentration in adipose tissue. Reported rates of SSI were 4.7% and 6.8% after administration of a single 1500 mg dose of CFX administrated after cord clamping (n = 144 women). There is limited data on pharmacokinetics of CFX for CS. There were no studies that reported CFX concentrations or SSI in obese women.
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Affiliation(s)
- Hanadi H Alrammaal
- Clinical Pharmacy department, Collage of Pharmacy, Umm Al-Qura University, Mecca, Mecca Province, Saudi Arabia; School of Pharmacy, Institute of Clinical Sciences, Robert Aitken Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom.
| | - Hannah K Batchelor
- School of Pharmacy, Institute of Clinical Sciences, Robert Aitken Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom.
| | - R Katie Morris
- Department of Fetal and Maternal Medicine, Birmingham Women's and Children's NHS Foundation Trust, Edgbaston, Birmingham, B15 2TG, United Kingdom; Institute for Metabolic and Systems Research, University of Birmingham, Birmingham, United Kingdom.
| | - Hsu P Chong
- Department of Fetal and Maternal Medicine, Birmingham Women's and Children's NHS Foundation Trust, Edgbaston, Birmingham, B15 2TG, United Kingdom; Institute for Metabolic and Systems Research, University of Birmingham, Birmingham, United Kingdom.
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22
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Impact of Early Exposure to Cefuroxime on the Composition of the Gut Microbiota in Infants Following Cesarean Delivery. J Pediatr 2019; 210:99-105.e2. [PMID: 31053348 DOI: 10.1016/j.jpeds.2019.03.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 02/28/2019] [Accepted: 03/04/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To assess in mothers giving birth by cesarean delivery if prophylactic antibiotics administered either before skin incision or immediately after cutting the umbilical cord influences gut microbiota colonization and antibiotic susceptibility of the gut bacteria in the newborn. STUDY DESIGN Forty-two pregnant women scheduled for elective cesarean delivery were recruited at Odense University Hospital, Denmark, and randomly assigned to receive cefuroxime either before skin incision or immediately after the umbilical cord was cut. Fecal samples were collected from all infants at age 10 days and 9 months. Composition of the gut microbiota was determined by 16S ribosomal RNA gene amplicon high-throughput sequencing. Gram-positive cocci and Enterobacteriaceae were isolated and identified before antimicrobial susceptibility tests were performed by disk diffusion. RESULTS No clear difference in the composition of the gut microbiota was observed between infants whose mothers received cefuroxime before or after cesarean delivery at neither time point, though surprisingly at 9 months of age, but not at 10 days of age, the number of observed species was higher in infants where mothers received cefuroxime after cord clamping. No differences in antimicrobial susceptibility of Enterobacteriaceae, Enterococcus spp, and Staphylococcus spp were seen at 10 days. CONCLUSIONS Timing of cefuroxime administration to mothers undergoing cesarean delivery does not have a major effect on the gut microbiota and bacterial antibiotic resistance traits in infants. TRIAL REGISTRATION Clinicaltrials.gov: NCT02072798.
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Abstract
Importance Surgical site infection (SSI) is a common complication of cesarean delivery. Seen in up to 12% of cesarean deliveries, it is a major cause of prolonged hospital stay and a burden to the healthcare system. Interventions and techniques must be identified to decrease the risk of cesarean delivery SSIs. Objective We review the categories of SSI, current studies that have focused on various interventions to decrease SSI, and preoperative, intraoperative, and postoperative recommendations for cesarean delivery SSI prevention. Evidence Acquisition A thorough search of PubMed for all current literature was performed. Various surgical interventions and techniques were reviewed. We included studies that looked at preoperative, intraoperative, and postoperative interventions for SSI prevention. Results We have summarized several surgical interventions and techniques as well as current consensus statements to aid the practitioner in preventing SSIs after cesarean delivery. Conclusions and Relevance Upon analysis of current data and consensus statements pertaining to cesarean deliveries, there are certain preoperative, intraoperative, and postoperative interventions and techniques that can be recommended to decrease the risk of cesarean delivery SSI.
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Milliken S, Allen RM, Lamont RF. The role of antimicrobial treatment during pregnancy on the neonatal gut microbiome and the development of atopy, asthma, allergy and obesity in childhood. Expert Opin Drug Saf 2019; 18:173-185. [PMID: 30739516 DOI: 10.1080/14740338.2019.1579795] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The use of antibiotics prenatally, during pregnancy, or neonatally may have adverse effects on the neonatal gut microbiome, and adversely affect the development of the infant immune system, leading to childhood atopy, asthma, allergy and obesity. AREAS COVERED Vaginal eubiosis and dysbiosis from molecular-based, cultivation-independent techniques, and how this affects the neonatal gut microbiome and early development of the immune system, the association between maternal antibiotics and the beneficial role of vitamin D in the development of atopy, asthma, allergy and obesity, efforts to reduce the use of antibiotics in pregnancy and therapeutic interventions such as vaginal 'seeding', probiotics, breastfeeding and neonatal dietary supplementation. EXPERT OPINION Currently available research gives insufficient attention to confounding variables. There remains uncertainty as to whether it is relevant that the mother suffered from the same condition as the purported infant outcome variable, for which she may have received antibiotics. In most studies, there is a lack of control for the number of antibiotic courses administered, the timing of use, the use of broad spectrum or narrow range antibiotics, the indication for antibiotics, the dose-dependent nature of the effect, the class of antibiotics used, or a varying degree of risk.
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Affiliation(s)
- Sarah Milliken
- a Department of Obstetrics and Gynaecology, Simpsons Centre for Reproductive Health , Royal Infirmary of Edinburgh , Edinburgh , UK
| | - Ruridh M Allen
- b Department of Gastroenterology, Division of Medicine , Royal Infirmary of Edinburgh , Edinburgh , UK
| | - Ronald F Lamont
- c Division of Surgery , University College London, Northwick Park Institute of Medical Research Campus , London , UK.,d Institute of Clinical Research , University of Southern Denmark , Odense , Denmark
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25
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Cost-effectiveness of antibiotic prophylaxis in elective cesarean section. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2018; 16:66. [PMID: 30574024 PMCID: PMC6299592 DOI: 10.1186/s12962-018-0168-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 12/11/2018] [Indexed: 11/10/2022] Open
Abstract
Background The proportion of pregnant women delivered by cesarean section has increased steadily during the past three decades. The risk of infection is 10-fold augmented after elective cesarean section compared to vaginal delivery. Antibiotic prophylaxis may reduce endometritis by 62% and superficial wound infection by 38% after elective cesarean section. International guidelines recommend antibiotic prophylaxis in elective cesarean section, but this procedure is not routinely followed in Sweden. Studies of costs of antibiotic prophylaxis in cesarean section show conflicting results and are based on substantially different incidence of postoperative infections. No study of costs of antibiotic prophylaxis in elective cesarean section in a Swedish or Nordic context has been pursued. The aim of this study was to investigate if antibiotic prophylaxis is cost-reducing in elective cesarean section in Örebro County, Sweden. Methods All women undergoing elective cesarean in the Region Örebro County health care system during 2011–2012 were eligible for inclusion. Postoperative infections and risk factors for infections were registered. A hypothetical situation in which all participants had received antibiotic prophylaxis was compared to the actual situation, in which none of them had received antibiotic prophylaxis. The reduction in the risk of postoperative infections resulting from antibiotic prophylaxis was based on a meta-analysis. Costs for in-patient care of postoperative infections were extracted from the accounting system, and costs for out-patient care were calculated according to standard costs. Costs for antibiotic prophylaxis were calculated and compared with the cost reduction that would be implied by the introduction of such prophylaxis. Results The incidences of deep and superficial surgical site infection were 3.5% and 1.3% respectively. Introduction of antibiotic prophylaxis would reduce health care costs by 31 Euro per cesarean section performed (95% credible interval 4–58 Euro). The probability of cost-saving was 99%. Conclusions Antibiotic prophylaxis in elective cesarean section is cost-reducing in this health care setting. Our results indicate that the introduction of antibiotic prophylaxis in elective cesarean section can also be cost-saving in low infection rate settings. Trial registration Ethical approval was given by the Regional Ethical Review Board in Uppsala (registration number 2013/484).
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Mohamed-Ahmed O, Hinshaw K, Knight M. Operative vaginal delivery and post-partum infection. Best Pract Res Clin Obstet Gynaecol 2018; 56:93-106. [PMID: 30992125 DOI: 10.1016/j.bpobgyn.2018.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/17/2018] [Accepted: 09/23/2018] [Indexed: 10/28/2022]
Abstract
During the past decade, there has been an increase in the awareness of infections associated with pregnancy and delivery. The most significant cause of post-partum infection is caesarean section; 20-25% of operations are followed by wound infections, endometritis or urinary tract infections. Approximately 13% of women in the UK undergo operative vaginal delivery (OVD) with forceps or vacuum, which is also associated with an increased risk of infection, estimated at 0.7%-16% of these deliveries. Despite this, previous reviews have identified only one small trial of antibiotic prophylaxis in 393 women and concluded that there was insufficient evidence to support the routine use of prophylactic antibiotics after OVD. The ANODE trial, a multicentre, blinded, placebo-controlled trial from the UK, is due to report findings from more than 3400 women in 2019 and will be the largest study to date of antibiotic prophylaxis following OVD.
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Affiliation(s)
- Olaa Mohamed-Ahmed
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Kim Hinshaw
- City Hospitals Sunderland NHS Foundation Trust, Faculty of Health Sciences, University of Sunderland, UK
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK.
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McCall SJ, Bunch KJ, Brocklehurst P, D'Arcy R, Hinshaw K, Kurinczuk JJ, Lucas DN, Stenson B, Tuffnell DJ, Knight M. The incidence, characteristics, management and outcomes of anaphylaxis in pregnancy: a population-based descriptive study. BJOG 2018; 125:965-971. [PMID: 29193647 PMCID: PMC6033185 DOI: 10.1111/1471-0528.15041] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to estimate the incidence of anaphylaxis in pregnancy and describe the management and outcomes in the UK. DESIGN A population-based descriptive study using the UK Obstetric Surveillance System (UKOSS). SETTING All consultant-led maternity units in the UK. POPULATION All pregnant women who had anaphylaxis between 1 October 2012 and 30 September 2015. Anaphylaxis was defined as a severe, life-threatening generalised or systemic hypersensitivity reaction. METHODS Prospective case notification using UKOSS. MAIN OUTCOME MEASURES Maternal mortality, severe maternal morbidity, neonatal mortality and severe neonatal morbidity. RESULTS There were 37 confirmed cases of anaphylaxis in pregnancy, giving an estimated incidence of 1.6 (95% CI: 1.1-2.2) per 100 000 maternities. Four cases of anaphylaxis were in women with known penicillin allergies: two received co-amoxiclav and two cephalosporins. Twelve women had anaphylaxis following prophylactic use of antibiotics at the time of a caesarean delivery. Prophylactic use of antibiotics for Group B streptococcal infection accounted for anaphylaxis in one woman. Two women died (5%), 14 (38%) women were admitted to intensive care and seven women (19%) had one or more additional severe maternal morbidities, which included three haemorrhagic events, two cardiac arrests, one thrombotic event and one pneumonia. No infants died; however, in those infants whose mother had anaphylaxis before delivery (n = 18) there were seven (41%) neonatal intensive care unit admissions, three preterm births and one baby was cooled for neonatal encephalopathy. CONCLUSIONS Anaphylaxis is a rare severe complication of pregnancy and frequently the result of a reaction to antibiotic administration. This study highlights the seriousness of the outcomes of this condition for the mother. The low incidence is reassuring given the large proportion of the pregnant population that receive prophylactic antibiotics during delivery. TWEETABLE ABSTRACT Anaphylaxis is a rare severe complication of pregnancy and frequently the result of a reaction to antibiotic administration.
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Affiliation(s)
- SJ McCall
- Policy Research Unit in Maternal Health and CareNational Perinatal Epidemiology Unit (NPEU)Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - KJ Bunch
- Policy Research Unit in Maternal Health and CareNational Perinatal Epidemiology Unit (NPEU)Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - P Brocklehurst
- Policy Research Unit in Maternal Health and CareNational Perinatal Epidemiology Unit (NPEU)Nuffield Department of Population HealthUniversity of OxfordOxfordUK
- Birmingham Clinical Trials UnitUniversity of BirminghamBirminghamUK
| | - R D'Arcy
- Nuffield Department of Obstetrics and GynaecologyJohn Radcliffe HospitalUniversity of OxfordOxfordUK
| | - K Hinshaw
- Department of Obstetrics and GynaecologySunderland Royal HospitalSunderlandUK
| | - JJ Kurinczuk
- Policy Research Unit in Maternal Health and CareNational Perinatal Epidemiology Unit (NPEU)Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - DN Lucas
- Department of AnaestheticsNorthwick Park HospitalLondonUK
| | - B Stenson
- Neonatal UnitRoyal Infirmary of EdinburghEdinburghUK
| | - DJ Tuffnell
- Teaching Hospitals Foundation NHS TrustBradfordUK
| | - M Knight
- Policy Research Unit in Maternal Health and CareNational Perinatal Epidemiology Unit (NPEU)Nuffield Department of Population HealthUniversity of OxfordOxfordUK
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Marchocki Z, Vinturache A, Collins K, O' Reilly P, O'Donoghue K. Amniotic fluid C-reactive protein as a predictor of infection in caesarean section: a feasibility study. Sci Rep 2018; 8:6372. [PMID: 29686267 PMCID: PMC5913132 DOI: 10.1038/s41598-018-24569-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 04/03/2018] [Indexed: 11/16/2022] Open
Abstract
This study evaluated the feasibility of maternal C-reactive protein (CRP) in amniotic fluid (AF) as a predictor of post-partum infection in women who undergo emergency or elective caesarean section (CS). AF bacterial culture and levels of hs-CRP in maternal serum and AF were evaluated in Day 0 and three days thereafter (Day 3) in 79 women undergoing CS. Univariate analyses assessed the clinical and demographic characteristics, whereas the ROC curves assessed the feasibility of hs-CRP as marker of inflammation in women who undergo CS. There was no difference in AF, Day 0, and Day 3 serum hs-CRP levels between women with sterile compared to those with bacterial growth in AF. Among women with positive AF cultures, AF and Day 0 serum hs-CRP levels were higher in women who underwent emergency compared to those who had elective CS (p = 0.04, and p = 0.02 respectively). hs-CRP in Day 0 and Day 3 serum but not in AF has a fair predictor value of infection in emergency CS only (AUC 0.767; 95% CI 0.606-0.928, and AUC 0.791; 95% CI 0.645-0.036, respectively). We conclude that AF hs-CRP is not feasible in assessing the risk of post-cesarean inflammation or infection.
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Affiliation(s)
- Zbigniew Marchocki
- Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Cork, Ireland
| | - Angela Vinturache
- John Radliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
| | - Kevin Collins
- Department of Microbiology, University College Cork, Cork, Ireland
| | - Paddy O' Reilly
- Department of Microbiology, University College Cork, Cork, Ireland
| | - Keelin O'Donoghue
- Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Cork, Ireland
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
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Huppertz H. Folgen perioperativer Antibiotikaprophylaxe bei Kaiserschnittentbindung für das Kind. Monatsschr Kinderheilkd 2018. [DOI: 10.1007/s00112-017-0345-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Martin EK, Beckmann MM, Barnsbee LN, Halton KA, Merollini KMD, Graves N. Best practice perioperative strategies and surgical techniques for preventing caesarean section surgical site infections: a systematic review of reviews and meta-analyses. BJOG 2018; 125:956-964. [DOI: 10.1111/1471-0528.15125] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2017] [Indexed: 12/16/2022]
Affiliation(s)
- EK Martin
- Institute of Health and Biomedical Innovation; Queensland University of Technology; Brisbane QLD Australia
| | - MM Beckmann
- Mater Health Services; Brisbane QLD Australia
| | - LN Barnsbee
- Institute of Health and Biomedical Innovation; Queensland University of Technology; Brisbane QLD Australia
| | - KA Halton
- Institute of Health and Biomedical Innovation; Queensland University of Technology; Brisbane QLD Australia
| | - KMD Merollini
- Faculty of Science, Health, Education and Engineering; University of the Sunshine Coast; Maroochydore QLD Australia
| | - N Graves
- Institute of Health and Biomedical Innovation; Queensland University of Technology; Brisbane QLD Australia
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Does surgical site infection after Caesarean section in Polish hospitals reflect high-quality patient care or poor postdischarge surveillance? Results from a 3-year multicenter study. Am J Infect Control 2018; 46:20-25. [PMID: 28967511 DOI: 10.1016/j.ajic.2017.07.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/26/2017] [Accepted: 07/26/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Caesarean sections (CSs) are associated with a high infection risk. Surgical site infection (SSI) incidence is among the markers of effectiveness of infection prevention efforts. The aim of this study was to analyze risk factors for SSI, incidence, and microbiology in patients who underwent CS. METHODS The study was conducted during 2013-2015 using active infection surveillance in 5 Polish hospitals according to the European Centre for Disease Prevention and Control surveillance network known as HAI-Net. For each procedure, the following data were registered: age, American Society of Anesthesiologists score, procedure time, elective or emergency procedure, use of perioperative antibiotic prophylaxis, microbiology, the treatment used, and other information. RESULTS SSI incidence was 0.5% and significant differences were noted among hospitals (between 0.1% and 1.8%), for different American Society of Anesthesiologists scales (between 0.2% and 4.8%) and different values of standardized SSI risk index (between 0.0% and 0.8%). In 3.1% of procedures, with no antibiotic prophylaxis, SSI risk was significantly higher. Deep infections dominated: 61.5% with superficial infections in only approximately 30% of cases and 2.6% of infections were detected postdischarge without readmissions. CONCLUSIONS Results showed high incidence of SSI in Poland without perioperative antibiotic prophylaxis, and secondly, ineffective surveillance according to CS status, considering outpatient obstetric care. Without postdischarge surveillance, it is not possible to recognize the epidemiologic situation, and further, to set priorities and needs when it comes to infection prophylaxis, especially because such low incidence may indicate no need for improvement in infection control.
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Bollig C, Nothacker M, Lehane C, Motschall E, Lang B, Meerpohl JJ, Schmucker CM. Prophylactic antibiotics before cord clamping in cesarean delivery: a systematic review. Acta Obstet Gynecol Scand 2017; 97:521-535. [PMID: 29215155 DOI: 10.1111/aogs.13276] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 11/25/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The number of clinical trials investigating the optimal timing of prophylactic antibiotics in cesarean section has increased rapidly over the last few years. We conducted a systematic review to inform up-to-date evidence-based guidelines to prevent postpartum infectious morbidity in the mother and rule out any safety issues related to antepartum antibiotic exposure in infants. MATERIAL AND METHODS Four bibliographic databases were searched for published reports of trials. Ongoing or unpublished studies were searched in Clinicaltrials.gov and the World Health Organization registry platform. Randomized controlled trials comparing antibiotic prophylaxis before and after cord clamping in cesarean section were eligible. Maternal and neonatal outcomes were assessed, and certainty of evidence graded. RESULTS In total, 18 randomized controlled trials met the inclusion criteria. Those women who received antibiotics preoperatively were 28% (relative risk 0.72, 95% confidence interval 0.56-0.92, nine studies, 4342 women, high quality of evidence) less likely to show infectious morbidity as compared with those who received antibiotics after cord clamping. The risk of endomyometritis and/or endometritis was reduced by 43% (relative risk 0.57, 95% confidence interval 0.40-0.82, 13 studies, 6250 women, high quality of evidence) and the risk of wound infection by 38% (relative risk 0.62, 95% confidence interval 0.47-0.81, 14 studies, 6450 women, high quality of evidence) in those who received antibiotics preoperatively as compared to those who received antibiotics after cord clamping. For other maternal infections no significant differences were identified. The risk for neonatal outcomes, such as deaths attributed to infection, sepsis, neonatal antibiotic treatment, intensive care unit admission or antibiotic-related adverse events, was not found to be different, either clinically or statistically, when antibiotics were given before or after cord clamping (moderate to low quality of evidence). CONCLUSIONS The evidence in favor of prophylactic antibiotic administration before, in comparison with after, cord clamping for major maternal infections was of high quality, meaning that further research would be unlikely to change the confidence in these findings. However, we recommend additional research reflecting the precision of the effect estimates for neonatal outcomes.
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Affiliation(s)
- Claudia Bollig
- Cochrane Germany, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Monika Nothacker
- AWMF-Institute for Medical Knowledge Management (IMWi), Marburg, Germany
| | - Cornelius Lehane
- Department of Anesthesiology and Critical Care, University Heart Center Freiburg-Bad Krozingen, Medical Center - University of Freiburg, Freiburg, Germany
| | - Edith Motschall
- Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Britta Lang
- Cochrane Germany, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Joerg J Meerpohl
- Cochrane Germany, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christine M Schmucker
- Cochrane Germany, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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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 2017; 32:804-808. [PMID: 29020828 DOI: 10.1080/14767058.2017.1391784] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cesarean section (CS) is one of the most common surgical procedures performed worldwide. Surgical-site-infection (SSI) occurs in approximately 5-10% of CS. The benefit of prophylactic antibiotics for prevention of SSI has been demonstrated in the literature. The optimal timing of antibiotic prophylaxis (prior to surgical incision versus after cord clamping) was investigated in recent studies. In January 2014, the Israeli Ministry of Health introduced a national quality measure which monitors the administration of prophylactic antibiotics in CS. The custom clinical practice in our medical center was to administer prophylactic antibiotics immediately after cord clamping. Upon introduction of the national quality measurement program, the practice was changed to administration of antibiotics prior to surgical incision. Our objective was to examine the effect of timing of prophylactic antibiotics administration on the incidence of SSI following CS, in a single medical center that performs a large volume of deliveries, with a low rate of CS. MATERIAL AND METHODS Taking advantage of a discrete change in clinical practice, we used retrospective data and applied difference-in-differences design to estimate the effect of the timing of prophylactic antibiotics administration on SSI rates. The analysis included all CSs performed during 2012-2015 and all hysterectomies conducted during the study period. RESULTS The coverage rates of prophylactic antibiotics in CS before and after the policy change were 99.10% and 99.03%, respectively. The rates of SSI following CS, before and after the policy change, were 2.63% (n = 2499) and 2.32% (n = 3840), respectively. The rates of SSI following hysterectomy, before and after the policy, change were 6.82% (n = 396) and 7.09% (n = 437), respectively. Difference-in-differences (DID) estimates of the effect of policy change on the incidence of SSI in linear and logistic regression models were not significant (B = -0.6%, p = .64; odds ratio = 0.84, p = .58, respectively). CONCLUSIONS We found no effect of the timing of prophylactic antibiotic administration (prior to surgical incision versus after cord clamping) on SSI rates following CS.
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Affiliation(s)
- Assaf Ben Shoham
- a Department of Internal Medicine , Shaare Zedek Medical Center , Jerusalem , Israel
| | - Maskit Bar-Meir
- b Department of Pediatric Infectious Diseases, Shaare Zedek Medical Center, Faculty of Medicine , Hebrew University of Jerusalem Hadassah Medical School , Jerusalem , Israel
| | - Alexander Ioscovich
- c Anesthesiology and Obstetric Anesthesiology Unit , Shaare Zedek Medical Center , Jerusalem , Israel
| | - Arnon Samueloff
- d Department of Obstetrics and Gynecology , Shaare Zedek Medical Center , Jerusalem , Israel
| | - Yonit Wiener-Well
- e Infectious Disease Unit , Shaare Zedek Medical Center , Jerusalem , Israel
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Suzuki Y, Matsuzaki S, Mimura K, Kumasawa K, Tomimatsu T, Endo M, Kimura T. Investigation of perioperative complications associated with use of uterine compression sutures. Int J Gynaecol Obstet 2017; 139:28-33. [DOI: 10.1002/ijgo.12249] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 04/28/2017] [Accepted: 06/26/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Yosuke Suzuki
- Department of Obstetrics and Gynecology; Osaka University Graduate School of Medicine; Osaka Japan
| | - Shinya Matsuzaki
- Department of Obstetrics and Gynecology; Osaka University Graduate School of Medicine; Osaka Japan
| | - Kazuya Mimura
- Department of Obstetrics and Gynecology; Osaka University Graduate School of Medicine; Osaka Japan
| | - Keiichi Kumasawa
- Department of Obstetrics and Gynecology; Osaka University Graduate School of Medicine; Osaka Japan
| | - Takuji Tomimatsu
- Department of Obstetrics and Gynecology; Osaka University Graduate School of Medicine; Osaka Japan
| | - Masayuki Endo
- Department of Obstetrics and Gynecology; Osaka University Graduate School of Medicine; Osaka Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology; Osaka University Graduate School of Medicine; Osaka Japan
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Rusconi F, Zugna D, Annesi-Maesano I, Baïz N, Barros H, Correia S, Duijts L, Forastiere F, Inskip H, Kelleher CC, Larsen PS, Mommers M, Andersen AMN, Penders J, Pike K, Porta D, Sonnenschein-van der Voort A, Sunyer J, Torrent M, Viljoen K, Vrijheid M, Richiardi L, Galassi C. Mode of Delivery and Asthma at School Age in 9 European Birth Cohorts. Am J Epidemiol 2017; 185:465-473. [PMID: 28399567 DOI: 10.1093/aje/kwx021] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 07/26/2016] [Indexed: 12/13/2022] Open
Abstract
Evidence on the association between mode of delivery and asthma at school age is inconclusive. We assessed the associations between specific modes of delivery and asthma in children from 9 European birth cohorts that enrolled participants between 1996 and 2006. Cohort-specific crude and adjusted risk ratios for asthma at ages 5-9 years were calculated using Poisson regression models and pooled. A sensitivity analysis was carried out in children born at term to reduce confounding due to perinatal factors. The study included 67,613 participants. Cohort-specific rates of cesarean delivery varied from 9.4% to 37.5%. Cesarean delivery, as opposed to vaginal delivery, was associated with an increased risk of asthma (adjusted risk ratio (aRR) = 1.22, 95% confidence interval (CI): 1.02, 1.46). Compared with spontaneous vaginal delivery, the adjusted risk ratio was 1.33 (95% CI: 1.02, 1.75) for elective cesarean delivery, 1.07 (95% CI: 0.94, 1.22) for emergency cesarean delivery, and 0.97 (95% CI: 0.84, 1.12) for operative vaginal delivery. In children born at term, the associations were strengthened only for elective cesarean delivery (aRR = 1.49, 95% CI: 1.13, 1.97). The large sample size allowed analysis of the associations between specific modes of delivery and asthma at school age. The increased risk of asthma associated with elective cesarean delivery, especially among children born at term, is relevant in counteracting the increasing use of this procedure, which is often performed without a clear medical indication.
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Pinto-Lopes R, Sousa-Pinto B, Azevedo LF. Single dose versus multiple dose of antibiotic prophylaxis in caesarean section: a systematic review and meta-analysis. BJOG 2017; 124:595-605. [PMID: 27885778 DOI: 10.1111/1471-0528.14373] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Prophylactic antibiotics are traditionally given as a single dose for caesarean section. However, inconsistent application of recommendations and recent evidence prompted a literature review. OBJECTIVES To assess the optimal regimen for antibiotic prophylaxis in caesarean section by comparing single versus multiple doses of the same intervention. SEARCH STRATEGY MEDLINE, Web of Knowledge, SCOPUS, CENTRAL and ongoing trials databases were searched. Reference lists were reviewed and international groups contacted. SELECTION CRITERIA Randomised controlled trials (RCT) comparing single with multiple dose regimens of the same antibiotic prophylaxis. Quasi-RCT and abstracts were suitable for inclusion. DATA COLLECTION AND ANALYSIS Reviewers independently extracted data and assessed quality of evidence. A random-effects model was used and results presented as risk ratio (RR) with 95% confidence intervals (CI). MAIN RESULTS Sixteen studies were included, involving 2695 women. Nonsignificant differences were observed between single dose and multiple dose antibiotic prophylaxis in the incidence of postpartum infectious morbidity (RR 0.95, 95% CI 0.75-1.20, I2 = 25%), endometritis (RR 1.03, 95% CI 0.74-1.42, I2 = 0%) and wound infection (RR 1.22, 95% CI 0.72-2.08, I2 = 0%). A trend towards lower risk of urinary tract infection was seen with multiple dose (RR 0.65, 95% CI 0.34-1.24, I2 = 0%). CONCLUSIONS There was insufficient evidence to determine whether there is a difference between single and multiple dose regimens in reducing the incidence of infectious morbidity after caesarean section. The quality of evidence was very low and well-designed RCTs are needed. TWEETABLE ABSTRACT Insufficient evidence of difference between dosage regimens of antibiotic prophylaxis in caesarean section.
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Affiliation(s)
- R Pinto-Lopes
- Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Health Information and Decision Sciences (CIDES) of the Faculty of Medicine and Centre for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal
| | - B Sousa-Pinto
- Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Health Information and Decision Sciences (CIDES) of the Faculty of Medicine and Centre for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal
| | - L F Azevedo
- Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Health Information and Decision Sciences (CIDES) of the Faculty of Medicine and Centre for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal
- Portuguese Branch of the Iberoamerican Cochrane Centre, Porto, Portugal
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Does current cefazolin dosing achieve adequate tissue and blood concentrations in obese women undergoing cesarean section? Eur J Obstet Gynecol Reprod Biol 2017; 210:334-341. [PMID: 28122314 DOI: 10.1016/j.ejogrb.2017.01.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/11/2017] [Accepted: 01/16/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Prophylactic administration of antibiotics preceding cesarean delivery is the most effective measure taken for preventing postpartum infection. While obese women are at greater risk for infection than non-obese women, evidence-based recommendations for modifying dosing in these women are limited. OBJECTIVES The purpose of this study was to determine whether obese women undergoing cesarean delivery similarly reach adequate cefazolin concentrations within tissue and blood when weighing <120kg and dosed 2g versus weighing ≥120kg and dosed 3g. STUDY DESIGN We prospectively studied women ≥18 years old with body mass index ≥30kg/m2 who underwent scheduled cesarean delivery with singleton pregnancy from August 2014 through March 2016. Women were dosed with 2g and 3g of cefazolin for body weights <120kg and ≥120kg, respectively. Samples of subcutaneous adipose tissue (following skin incision and before skin closure), myometrial tissue, fetal cord blood, and maternal blood were collected to assess whether cefazolin concentrations were adequate, i.e., at/above the minimum inhibitory concentration (MIC). Concentrations, based on inhibition zones for Streptococcus sanguinis, were calculated per gram of solid tissue and milliliter of blood. For all sample types, log-transformed concentrations were compared between dosage groups. Using a range of published MICs (1-8μg/mL or μg/g), odds ratios, describing differential odds of falling below the MIC between dosage groups, were also computed. RESULTS Women who received 2g (n=65) versus 3g (n=19) of cefazolin did not significantly differ by maternal or gestational age, race/ethnicity, pre-operative hemoglobin, estimated blood loss, fluid administration, duration of surgery, or timing of sample collections relative to cefazolin administration (Ps>0.05). Dosage groups also did not differ in cefazolin concentration (median [interquartile range]) within adipose tissue following skin incision (5.30μg/g [3.00-9.60] vs. 6.35μg/g [3.90-8.40]; P=0.551), adipose tissue before skin closure (4.45μg/g [2.78-7.25] vs. 6.90μg/g [2.60-10.6]; P=0.342), myometrial tissue (13.1μg/g [8.60-19.6] vs. 15.7μg/g [10.8-21.7]; P=0.116), or maternal blood (41.6μg/mL [26.3-57.0] vs. 45.3μg/mL [36.7-68.3]; P=0.143). However, cord blood concentrations differed significantly (19.5μg/mL [13.7-28.5] vs. 27.9μg/mL [15.8-39.4]; P=0.032), and, in 3 of 5 sample types, group concentrations differed at the dosing cut-point of 120kg (Ps<0.02). Within the range of MICs considered, differences in the odds of concentration inadequacy were not detected between dosage groups for any sample type. Across all patients, inadequate concentrations in one or more solid tissue types were observed in 1.19%, 17.9%, 59.5%, and 86.9% of patients, given the MICs of 1μg/g, 2μg/g, 4μg/g and 8μg/g, respectively. In adipose tissues, specifically, and both dosage groups, mean concentrations were significantly lower than the MIC of 8μg/g (Ps<0.03). Concentrations in one or both blood sample types were inadequate for only 8.33% of patients, given the 8-μg/mL MIC. CONCLUSIONS Adequate cefazolin concentrations were achieved in blood for the majority of our patients. However, concentration adequacy was not achieved in solid tissue for a nearly equally large proportion of patients. Larger scale studies for determining modified protocols for dosing and applying MICs are warranted.
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Liu R, Lin L, Wang D. Antimicrobial prophylaxis in caesarean section delivery. Exp Ther Med 2016; 12:961-964. [PMID: 27446303 PMCID: PMC4950587 DOI: 10.3892/etm.2016.3350] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 05/17/2016] [Indexed: 11/06/2022] Open
Abstract
Antimicrobial prophylaxis is used routinely for pre-, intra- and post-operative caesarean section. One of the most important risk factors for postpartum infection is caesarean delivery. Caesarean section shows a higher incidence of infection than vaginal delivery. It is complicated by surgical site infections, endometritis or urinary tract infection. The aim of the present study was to assess the usage of antimicrobials in women undergoing caesarean section at a Tertiary Care Hospital. A prospective study was conducted in 100 women during the period of February 2013 to August 2013 in the inpatient Department of Gynaecology and Obstetrics. Data collected included the age of the patient, gravidity, and type of caesarean section, which was analyzed for the nature and number of antimicrobials prescribed, duration of treatment, polypharmacy, fixed-dose combinations, generic/brand names used and failure of prophylaxis. Antimicrobial prophylaxis was administered to the patients. The most commonly prescribed antimicrobial was a combination of ceftriaxone and sulbactam. Of 100 patients, 87% were aged 20-35 years. The highest proportion of patients were primigravida 72%. Elective procedure was carried out in 38%, the remaining were emergency C-section in whom intra- and post-operative antimicrobial prophylaxis was given for a duration of 7 days. In total, 27% of patients were reported with infection even after the antimicrobial prophylaxis. In conclusion, pre-operative prophylaxis was given in the early rupture of membranes. Fixed-dose combinations were preferred. Incidence of infection even after antimicrobial prophylaxis was reported due to pre-existing infection, debilitating disease or prolonged rupture of membranes. Patients with recurrent infection were shifted to amoxicillin and clavulinic acid combination. Drugs were prescribed only by brand names which is of concern.
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Affiliation(s)
- Ronghua Liu
- Department of Obstetrics, People's Hospital of Linyi, Linyi, Shandong 276000, P.R. China
| | - Lin Lin
- Department of Obstetrics, People's Hospital of Linyi, Linyi, Shandong 276000, P.R. China
| | - Dujuan Wang
- Department of Obstetrics, People's Hospital of Linyi, Linyi, Shandong 276000, P.R. China
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Nabhan AF, Allam NE, Hamed Abdel‐Aziz Salama M. Routes of administration of antibiotic prophylaxis for preventing infection after caesarean section. Cochrane Database Syst Rev 2016; 2016:CD011876. [PMID: 27314174 PMCID: PMC8572032 DOI: 10.1002/14651858.cd011876.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Post-caesarean section infection is a cause of maternal morbidity and mortality. Administration of antibiotic prophylaxis is recommended for preventing infection after caesarean delivery. The route of administration of antibiotic prophylaxis should be effective, safe and convenient. Currently, there is a lack of synthesised evidence regarding the benefits and harms of different routes of antibiotic prophylaxis for preventing infection after caesarean section. OBJECTIVES The aim of this review was to assess the benefits and harms of different routes of prophylactic antibiotics given for preventing infectious morbidity in women undergoing caesarean section. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2016), ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (6 January 2016) and reference lists of retrieved studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing at least two alternative routes of antibiotic prophylaxis for caesarean section (both elective and emergency). Cross-over trials and quasi-RCTs were not eligible for inclusion. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion, assessed the risk of bias and extracted data from the included studies. These steps were checked by a third review author. MAIN RESULTS We included 10 studies (1354 women). The risk of bias was unclear or high in most of the included studies.All of the included trials involved women undergoing caesarean section whether elective or non-elective. Intravenous antibiotics versus antibiotic irrigation (nine studies, 1274 women) Nine studies (1274 women) compared the administration of intravenous antibiotics with antibiotic irrigation. There were no clear differences between groups in terms of this review's maternal primary outcomes: endometritis (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.70 to 1.29; eight studies (966 women) (low-quality evidence)); wound infection (RR 0.49, 95% CI 0.17 to 1.43; seven studies (859 women) (very low-quality evidence)). The outcome of infant sepsis was not reported in the included studies.In terms of this review's maternal secondary outcomes, there were no clear differences between intravenous antibiotic or irrigation antibiotic groups in terms of postpartum febrile morbidity (RR 0.87, 95% CI 0.48 to 1.60; three studies (264 women) (very low-quality evidence)); or urinary tract infection (RR 0.74, 95% CI 0.25 to 2.15; five studies (660 women) (very low-quality evidence)). In terms of adverse effects of the treatment on the women, no drug allergic reactions were reported in three studies (284 women) (very low-quality evidence), and there were no cases of serious infectious complications reported (very low-quality evidence). There was no clear difference between groups in terms of maternal length of hospital stay (mean difference (MD) 0.28 days, 95% CI -0.22 to 0.79 days, (random-effects analysis), four studies (512 women). No data were reported for the number of women readmitted to hospital. For the baby, there were no data reported in relation to oral thrush, infant length of hospital stay or immediate adverse effects of the antibiotics on the infant. Intravenous antibiotic prophylaxis versus oral antibiotic prophylaxis (one study, 80 women) One study (80 women) compared an intravenous versus an oral route of administration of prophylactic antibiotics, but did not report any of this review's primary or secondary outcomes. AUTHORS' CONCLUSIONS There was no clear difference between irrigation and intravenous antibiotic prophylaxis in reducing the risk of post-caesarean endometritis. For other outcomes, there is insufficient evidence regarding which route of administration of prophylactic antibiotics is most effective at preventing post-caesarean infections. The quality of evidence was very low to low, mainly due to limitations in study design and imprecision. Furthermore, most of the included studies were underpowered (small sample sizes with few events). Therefore, we advise caution in the interpretation and generalisability of the results.For future research, there is a need for well-designed, properly-conducted, and clearly-reported RCTs. Such studies should evaluate the more recently available antibiotics, elaborating on the various available routes of administration, and exploring potential neonatal side effects of such interventions.
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Affiliation(s)
- Ashraf F Nabhan
- Ain Shams UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine16 Ali Fahmi Kamel StreetHeliopolisCairoEgypt11351
| | - Nahed E Allam
- Alazhar UniversityDepartment of Obstetrics and GynaecologyAlmostashfa Elyounainy StCairoEgypt
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Lalic-Popovic M, Paunkovic J, Grujic Z, Golocorbin-Kon S, Milasinovic L, Al-Salami H, Mikov M. Decreased placental and transcellular permeation of cefuroxime in pregnant women with diabetes. J Diabetes 2016; 8:238-45. [PMID: 25800069 DOI: 10.1111/1753-0407.12288] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 01/16/2015] [Accepted: 02/12/2015] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The present study investigated the transcellular and placental permeation of cefuroxime, an antibiotic used in cesarean sections, in pregnant women with diabetes and hypertension. METHODS Fifty-three women scheduled for cesarean section were divided into three groups: healthy women (n = 18), women with arterial hypertension (n = 21), and women with gestational diabetes (n = 14). All women received 1.5 g, i.v., cefuroxime. Cefuroxime concentrations were measured in maternal venous plasma before, during, and after delivery, as well as in fetal umbilical cord vein and artery plasma during delivery. The effects of diabetes and hypertension on cefuroxime placental-permeation were assessed by the fetomaternal plasma concentration ratios. Pharmacokinetic non-compartmental model analyses were performed and results were compared using anova. RESULTS Fetomaternal drug concentration ratios were lower in the diabetic group than in the hypertensive and control groups. There were no significant differences in umbilical arterial : venous plasma drug concentration ratios in the diabetic and hypertensive groups compared with the control group. Apparent volume of distribution and clearance were significantly lower in the diabetic group compared with the control and hypertensive groups. CONCLUSIONS Diabetes led to decreased placental transfer of cefuroxime, as well as volume of distribution and clearance, but did not affect other pharmacokinetic parameters. Hypertension had no significant effect on the permeation of cefuroxime or on its pharmacokinetics. Prophylactic concentrations of cefuroxime were reached in all groups, but the dosing time of cefuroxime should not be less than 30 min or greater than 2 h prior to delivery.
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Affiliation(s)
- Mladena Lalic-Popovic
- Department of Pharmacy, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Jovana Paunkovic
- Health Department in Novi Sad for Women Health Protection, Novi Sad, Serbia
| | - Zorica Grujic
- Department of Gynecology and Obstetrics, Clinical Centre of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | | | - Ljubomir Milasinovic
- Department of Gynecology and Obstetrics, Clinical Centre of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Hani Al-Salami
- School of Pharmacy, Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Momir Mikov
- Department of Pharmacology, Toxycology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
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Nabhan AF, Allam NE, Hamed Abdel-Aziz Salama M. Routes of administration of antibiotic prophylaxis for preventing infection after caesarean section. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Zhang C, Zhang L, Liu X, Zhang L, Zeng Z, Li L, Liu G, Jiang H. Timing of Antibiotic Prophylaxis in Elective Caesarean Delivery: A Multi-Center Randomized Controlled Trial and Meta-Analysis. PLoS One 2015; 10:e0129434. [PMID: 26148063 PMCID: PMC4492889 DOI: 10.1371/journal.pone.0129434] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 04/26/2015] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To compare the effectiveness of antibiotic prophylaxis before skin incision with that after umbilical cord clamping in elective caesarean delivery. METHODS We conducted a randomized open-label controlled trial with two parallel arms at three hospitals in western China. Participants meeting the inclusion criteria received antibiotics 30-60 minutes before skin incision while others received antibiotics after umbilical cords clamping. For the meta-analysis, studies were identified from the database of PUBMED, Cochrane Library and EMbase and assessed using the Cochrane risk of bias tool. RESULTS Four hundred and ten patients were randomized to receive antibiotics before skin incision (n = 205) or after umbilical cords clamping (n = 205). There was no difference in the incidence of postpartum endometritis (RR = 0.34, 95% CI 0.04 to 3.24), wound infection (RR = 3.06, 95% CI 0.13 to 74.69) and total puerperal morbidity (RR = 1.02, 95% CI 0.47 to 2.22). No increase in the incidence of neonatal sepsis (RR = 0.34, 95% CI 0.04 to 3.24), septic workup (RR = 0.41, 95% CI 0.08 to 2.07), or intermediate NICU admission (RR = 0.73, 95% CI 0.24 to 2.26) was observed. The meta-analysis involving nine RCTs showed that no statistically significant difference was found in terms of the risk of postpartum endometritis (RR = 0.73, 95% CI 0.39, 1.36), wound infection (RR = 0.80, 95%CI 0.55, 1.17), or puerperal morbidity (RR = 0.89, 95% CI 0.70, 1.13). No increase in the incidence of neonatal sepsis (RR = 0.65, 95% CI 0.35 to 1.20), septic workup (RR = 0.88, 95% CI 0.50 to 1.54), or intermediate NICU admission (RR = 0.91, 95% CI 0.70 to 1.18) was observed. CONCLUSION For elective caesarean delivery, the effects of antibiotic prophylaxis before skin incision and after umbilical cord clamping were equal. Both antibiotic prophylaxis before skin incision and that after umbilical cord clamping were recommended for elective caesarean delivery. The outcome of further studies should address both maternal and neonatal infectious morbidity as well as long-term neonatal follow up. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR-TRC-11001853.
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Affiliation(s)
- Chuan Zhang
- Department of Pharmacy, Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Lingli Zhang
- Department of Pharmacy, Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Xinghui Liu
- Department of Obstetric & Gynecologic, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Li Zhang
- Department of Obstetric & Gynecologic, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Zhiyou Zeng
- Department of Pharmacy, Nanchong Central Hospital, Nanchong, Sichuan, China
| | - Lin Li
- Department of Pharmacy, Nanchong Central Hospital, Nanchong, Sichuan, China
| | - Guanjian Liu
- The Chinese Cochrane Center, West China Hospital, Chengdu, Sichuan, China
| | - Hong Jiang
- Department of Obstetric & Gynecologic, Suining Central Hospital, Suining, Sichuan, China
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Dlamini LD, Sekikubo M, Tumukunde J, Kojjo C, Ocen D, Wabule A, Kwizera A. Antibiotic prophylaxis for caesarean section at a Ugandan hospital: a randomised clinical trial evaluating the effect of administration time on the incidence of postoperative infections. BMC Pregnancy Childbirth 2015; 15:91. [PMID: 25884350 PMCID: PMC4417223 DOI: 10.1186/s12884-015-0514-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 03/20/2015] [Indexed: 11/10/2022] Open
Abstract
Background Prophylactic antibiotics are used to prevent postoperative infections after caesarean section. Studies have suggested that the timing of prophylaxis plays an important role. Over the years, the role of the anaesthesiologist in the administration of prophylactic antibiotics has become prominent. Therefore, there is an increasing need for anaesthesia providers to understand the rationale of antibiotic prophylaxis. We therefore sought to compare the effect of antibiotics prophylaxis within 1 hour before skin incision and after skin incision on the incidence of postoperative infections in patients undergoing caesarean section at Mulago Hospital. Methods We conducted a single-blind randomised clinical trial conducted at Mulago Hospital evaluating 464 patients undergoing emergency caesarean section. Patients were randomly assigned a group number that allocated them to either arm of the study. They received the same prophylactic antibiotic according to their allotment, that is, either within 1 hour before skin incision or after skin incision as per current standards of practice in Mulago Hospital. They were followed up to detect infection up to 10 days postoperatively. The primary outcome was postoperative infection. The data collected were analysed with STATA version 12 using univariate and bivariate analysis. Results The risk of overall postoperative infection was significantly lower when prophylaxis was given within an hour before incision (RR O.77, 95% CI 0.62–0.97). We also found endometritis to be significantly reduced in the pre-incision group (RR 0.62; 95% CI 0.39–0.99; P value 0.036). Conclusions Giving prophylactic antibiotics before skin incision reduces risk of postoperative infection, in particular of endometritis. Trial registration Pan African Clinical Trial Registry PACTR201311000610495. Date of trial registration: 12th August 2013.
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Affiliation(s)
- Lomangisi D Dlamini
- Department of Anaesthesia, Makerere University, P.O. Box 7072, Kampala, Uganda.
| | - Musa Sekikubo
- Department of Obstetrics and Gynaecology, Makerere University, Kampala, Uganda.
| | - Janat Tumukunde
- Department of Anaesthesia, Makerere University, P.O. Box 7072, Kampala, Uganda.
| | - Charles Kojjo
- Department of Anaesthesia, Makerere University, P.O. Box 7072, Kampala, Uganda.
| | - Davidson Ocen
- Department of Anaesthesia, Makerere University, P.O. Box 7072, Kampala, Uganda.
| | - Agnes Wabule
- Department of Anaesthesia, Makerere University, P.O. Box 7072, Kampala, Uganda.
| | - Arthur Kwizera
- Department of Anaesthesia, Makerere University, P.O. Box 7072, Kampala, Uganda.
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Gidiri MF, Ziruma A. A randomized clinical trial evaluating prophylactic single-dose vs prolonged course of antibiotics for caesarean section in a high HIV-prevalence setting. J OBSTET GYNAECOL 2015; 34:160-4. [PMID: 24456438 DOI: 10.3109/01443615.2013.832737] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The evidence that perioperative antibiotics for caesarean delivery are effective in reducing infective morbidity is unequivocal. In developing countries, especially those with high HIV-prevalence, clinicians have increasingly become anxious about the efficacy of perioperative antibiotics, hence the adoption of treatment regimens, as described in this study. We set out to investigate if these fears have a basis by conducting a randomised clinical trial. The setting was two tertiary units in a developing country with a significant HIV-prevalence. The outcome measures assessed were: pyrexia, wound infection, admission with puerperal sepsis, laparotomy for pelvic abscess and duration of hospital stay. There was no statistically significant difference between the two arms of the study with regard to the above outcomes. Our conclusion is that the two antibiotic regimens are equivalent in preventing infection, therefore there is no justification for subjecting patients to week-long antibiotics and the unnecessary increase in nurse workload.
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Affiliation(s)
- M F Gidiri
- Academic Department of Obstetrics and Gynaecology, University of Zimbabwe College of Health Sciences, Parirenyatwa Hospital and Mbuya Nehanda Maternity Hospital , Avondale, Harare , Zimbabwe
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Westen EH, Kolk PR, van Velzen CL, Unkels R, Mmuni NS, Hamisi AD, Nakua RE, Vlek AL, van Beekhuizen HJ. Single-dose compared with multiple day antibiotic prophylaxis for cesarean section in low-resource settings, a randomized controlled, noninferiority trial. Acta Obstet Gynecol Scand 2014; 94:43-9. [DOI: 10.1111/aogs.12517] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Accepted: 09/22/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Esther H.M.N. Westen
- Mkomaindo District Hospital; Masasi Tanzania
- Department of Obstetrics and Gynecology; Máxima Medical Center; Veldhoven the Netherlands
| | - Pascal R. Kolk
- Mkomaindo District Hospital; Masasi Tanzania
- Department of Obstetrics and Gynecology; Radboud University Medical Center; Nijmegen the Netherlands
| | - Christine L. van Velzen
- Department of Obstetrics and Gynecology; VU University Medical Centre; Amsterdam the Netherlands
| | - Regine Unkels
- Sokoine Regional Hospital; Lindi Tanzania
- Liverpool School of Tropical Medicine; Liverpool UK
| | | | | | | | - Anne L.M. Vlek
- Department of Medical Microbiology; Diakonessen Hospital; Utrecht the Netherlands
| | - Heleen J. van Beekhuizen
- Sokoine Regional Hospital; Lindi Tanzania
- Department of Obstetrics and Gynecology; Erasmus Medical Center; Rotterdam the Netherlands
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Lamont HF, Blogg HJ, Lamont RF. Safety of antimicrobial treatment during pregnancy: a current review of resistance, immunomodulation and teratogenicity. Expert Opin Drug Saf 2014; 13:1569-81. [PMID: 25189188 DOI: 10.1517/14740338.2014.939580] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The extent of antibiotic use in pregnancy remains unknown but may occur in > 40% of pregnant women for various indications, at different gestational ages from different sources. AREAS COVERED Antibiotic resistance, alterations to the neonatal immune system causing allergy, asthma and atopic disease in later life and teratogenicity. EXPERT OPINION Although teratogenesis is not a major concern, it is important, and ignorance and complacency cast a long shadow. Robust evidence exists to guide clinicians in their choice of a safe agent with respect to teratogenicity. Antibiotic resistance is a major safety concern, and together with decreased research and development of new antibiotic agents, it has required legal initiatives to encourage Big Pharma to search for safe alternatives. New information from culture-independent, molecular-based techniques has resulted in a greater understanding of the adverse effects of antepartum/intrapartum antibiotics on the maternal vaginal microbiome and the neonatal gut microbiome. As this might adversely affect the development of the immature immune system and lead to asthma, allergy and atopic disease in later life, new research merits support in scrutinizing the safety of antibiotic use in pregnancy.
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Affiliation(s)
- Harriet F Lamont
- University of Southampton, Southampton General Hospital, Faculty of Medicine , Tremona Road, Southampton, SO16 6YD , UK
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Martinez de Tejada B. Antibiotic use and misuse during pregnancy and delivery: benefits and risks. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:7993-8009. [PMID: 25105549 PMCID: PMC4143845 DOI: 10.3390/ijerph110807993] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 07/25/2014] [Accepted: 07/28/2014] [Indexed: 11/17/2022]
Abstract
Although pregnancy is considered as a physiological state, most pregnant women in developed countries receive multiple medications to prevent maternal or neonatal complications, with antibiotics among the most frequently prescribed. During pregnancy, antibiotics are often prescribed in the context of preterm labor, intrapartum fever, prevention of neonatal Group B Streptococcus fever, and cesarean section. Outside this period, they are commonly prescribed in the community setting for respiratory, urinary, and ear, nose and throat infection symptoms. Whereas some of the current indications have insightful reasons to justify their use, potential risks related to overuse and misuse may surpass the benefits. Of note, the recent 2014 World Health Assembly expressed serious concern regarding antibiotic resistance due to antibiotic overuse and misuse and urged immediate action to combat antibiotic resistance on a global scale. Most studies in the obstetrics field have focused on the benefits of antibiotics for short-term maternal and neonatal complications, but with very little (if any) interest in long-term consequences.
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Parriott AM, Chow AL, Arah OA. Inadequate research on methicillin-resistant Staphylococcus aureus risk among postpartum women. Expert Rev Anti Infect Ther 2014; 11:1127-30. [PMID: 24151831 DOI: 10.1586/14787210.2013.850027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Andrea M Parriott
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (UCLA), CA 90095-1772, USA
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Craciunas L, Tsampras N. A literature review of the current evidence for routine antibiotic prophylaxis after cervical tissue excisions. J OBSTET GYNAECOL 2014; 34:700-5. [PMID: 24911246 DOI: 10.3109/01443615.2014.920786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Consistent data are available on supporting the routine use of prophylactic antibiotics for several obstetrical and gynaecological procedures. According to the Surgical Wounds Classification scheme, operations involving the vagina are included in the clean-contaminated category of procedures, and guidelines recommend the routine use of prophylactic antibiotics. The objective of this paper is to review the current evidence regarding prophylactic antibiotics for cervical tissue excisions. We performed a systematic search of medical databases to March 2014 and we found three randomised controlled trials reporting on the role of prophylactic antibiotics in 683 patients who underwent cervical excisions. When compared with controls, the prophylactic antibiotics group was similar in terms of postoperative bleeding, vaginal discharge, pain, incidence of adverse events, requirement of antibiotics and readmission rate secondary to bleeding. This systematic review based on three randomised controlled trials suggests that current evidence does not support the routine prophylactic antibiotics for cervical tissue excisions.
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Affiliation(s)
- L Craciunas
- Department of Obstetrics and Gynaecology, St Mary's Hospital , Manchester , UK
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Morisaki N, Ganchimeg T, Ota E, Vogel JP, Souza JP, Mori R, Gülmezoglu AM. Maternal and institutional characteristics associated with the administration of prophylactic antibiotics for caesarean section: a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG 2014; 121 Suppl 1:66-75. [PMID: 24641537 DOI: 10.1111/1471-0528.12632] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To illustrate the variability in the use of antibiotic prophylaxis for caesarean section, and its effect on the prevention of postoperative infections. DESIGN Secondary analysis of a cross-sectional study. SETTING Twenty-nine countries participating in the World Health Organization Multicountry Survey on Maternal and Newborn Health. POPULATION Three hundred and fifty-nine health facilities with the capacity to perform caesarean section. METHODS Descriptive analysis and effect estimates using multilevel logistic regression. MAIN OUTCOME MEASURES Coverage of antibiotic prophylaxis for caesarean section. RESULTS A total of 89 121 caesarean sections were performed in 332 of the 359 facilities included in the survey; 87% under prophylactic antibiotic coverage. Thirty five facilities provided 0-49% coverage and 77 facilities provided 50-89% coverage. Institutional coverage of prophylactic antibiotics varied greatly within most countries, and was related to guideline use and the practice of clinical audits, but not to the size, location of the institution or development index of the country. Mothers with complications, such as HIV infection, anaemia, or pre-eclampsia/eclampsia, were more likely to receive antibiotic prophylaxis. At the same time, mothers undergoing caesarean birth prior to labour and those with indication for scheduled deliveries were also more likely to receive antibiotic prophylaxis, despite their lower risk of infection, compared with mothers undergoing emergency caesarean section. CONCLUSIONS Coverage of antibiotic prophylaxis for caesarean birth may be related to the perception of the importance of guidelines and clinical audits in the facility. There may also be a tendency to use antibiotics when caesarean section has been scheduled and antibiotic prophylaxis is already included in the routine clinical protocol. This study may act as a signal to re-evaluate institutional practices as a way to identify areas where improvement is possible.
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Affiliation(s)
- N Morisaki
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan; Department of Paediatrics, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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