Pre-cesarean antibiotics cut infection risk

By Sally Robertson, B.Sc.Aug 9 2012

Administering prophylactic antibiotics before women undergo cesareans significantly reduces postsurgical infection rates, show US study findings.

Giving the antibiotics to patients before surgical incision was made, rather than at the time of cord clamp, reduced the incidence of site infection by almost 50%.

"Until recently, standard practice in the US was to give antibiotics when the baby was delivered, after the umbilical cord was clamped," said lead author David Warren, from Washington University School of Medicine, in a press statement. "Our findings support giving antibiotics just before a cesarean section to prevent infections."

As reported in Obstetrics and Gynecology, the results come from a time series analysis of the effect of three policy changes adopted at Barnes-Jewish Hospital in St Louis in January 2004, as part of routine quality improvement. The new policies included the administration of prophylactic antibiotics before surgery instead of after umbilical cord clamping, streamlined cleaning of the operating environment, and a ban of artificial nails among surgical staff.

The team retrospectively analyzed the effects of the policy changes in a large cohort of women who underwent cesarean delivery between January 2003 and December 2010, following official changes to practice guidelines in 2011 recommending antibiotic prophylaxis for all patients to be administered within 60 minutes before the start of cesarean delivery.

The researchers report that, according to standard care definitions, site infection occurred in 303 (3.5%) of 8668 procedures performed during this period.

Univariable time series analysis revealed that the incidence of post-cesarean surgical site infection was significantly influenced by the following factors: White race, age of 35 years or older, body mass index (BMI) of 35 kg/m² or greater at time of delivery, the antibiotic prophylaxis policy, and the artificial nails policy.

However, multivariable analysis of these five factors showed that only the prophylactic antibiotic policy was significantly associated with post-cesarean surgical site infection rates.

Implementation of the policy to administer prophylactic antibiotics within 1 hour before incision led to a 48% reduction in cesarean delivery surgical site infection, compared with administration at the time of cord clamp.

"Future research should aim at understanding adherence to this policy and best practices for delivering prophylactic antibiotics in a timely manner in both routine and emergency obstetric situations," concludes the team.

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