Short versus Long-Term Antibiotic Prophylaxis in Cesarean Section

Cesareans delivery is the most common risk factor for postpartum maternal infections, which occurs at a rate of 18%–38%. Factors that have been associated with an increased risk of infection among women who have a cesarean delivery include emergency cesarean section, labor and its duration, ruptured membranes and the duration of rupture, the use of prophylactic antibiotics or not, the socioeconomic status of the woman, number of prenatal visits, vaginal examinations during labor, anemia, blood loss, obesity, diabetes, general anesthesia, the skill of the operator and the operative technique.

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Antibiotic prophylaxis has been documented to reduce the incidence of endometritis after cesarean delivery by as much as 66%–75%. Surgical site infections are also reduced by prophylactic antibiotics.

The benefits of shorter regimens have been found to be equally effective as long-term prophylactic regimens may include convenient dosing regimens, ensuring full compliance, and saving man-hours dedicated to the administration of antibiotics in a human resource-challenged environment.

This study has the objective of determining if there is any significant difference between the incidence of postcesarean section wound infection with the use of a 48-h prophylactic antibiotics regimen (intravenous [IV] cefuroxime and metronidazole) compared to 48 h IV antibiotics followed by a 5-day course of oral antibiotics following cesarean section in a low-resource setting.

Escherichia coli was the most common organism cultured and was seen in 36.4% of the surgical site infections. Staphylococcus aureus was the second in occurrence and was seen in 27.3% of infections. Pseudomonas aeruginosa accounted for 18.2% of the infections, Klebsiella pneumoniae and Proteus vulgaris, each accounted for 9.1% of the infections.

This study demonstrated that there was no significant difference in the rate of postoperative wound infections between the use of 48-h cefuroxime and metronidazole regimen versus 7 days regimen on the development of surgical site infection and endometritis. This result correlates the recommendation by the World health organization as well as Royal College of Obstetricians and Gynaecologistson short-term antibiotics prophylaxis for cesarean section.

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CONCLUSIONS

This study has demonstrated that short-term antibiotic prophylaxis is as effective as long-term prophylaxis in preventing post cesarean section wound infection and endometritis in women with no added risks for infection.

Short-term prophylaxis also has the added benefit of being cost-effective, shorter stay in the hospital for the patient and may, therefore, reduce nosocomial infections.

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Abstract

Objective:

The objective of the present study was to compare the efficacy of intravenous (IV) 48 h course of cefuroxime/metronidazole with long-term course using 48 h cefuroxime/metronidazole plus 5 days oral regimen of cefuroxime and metronidazole for the prevention of post cesarean section wound infection.

Methods:

Two hundred and forty-eight women were randomized into two equal groups. Women in each arm of the study received IV cefuroxime 750 mg twelve hourly and IV metronidazole 400 mg eight hourly for 48 h. Those in the long-term arm received additional tablets of cefuroxime 500 mg twelve hourly and Tabs 400 mg of metronidazole eight hourly for 5 days. After the surgery, surgical site infections were evaluated. Length of hospital stay and the cost of antibiotics were also assessed.

Results:

The wound infection rate was not statistically significantly different between the 2 groups. The incidence of endometritis was 2.1%, with no statistically significant difference seen between the two groups. Escherichia coli was the most common isolate seen in 36.4% of infected wounds. The short arm group stayed for significantly shorter days in the hospital, and the cost of antibiotics was also significantly less in the short arm group (P < 0.001). Organisms associated with nosocomial infections were seen only in the long arm that stayed in the hospital for longer days.

Conclusions:

Short-term prophylactic antibiotics are as effective as long-term prophylaxis and have other benefits such as shorter duration of hospital stay, reduced cost of antibiotics, and reduction of nosocomial infections.

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