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Antimicrobial prophylaxis administration after umbilical cord clamping in cesarean section and the risk of surgical site infection: a cohort study with 55,901 patients


Sommerstein, Rami; Marschall, Jonas; Atkinson, Andrew; Surbek, Daniel; Dominguez-Bello, Maria Gloria; Troillet, Nicolas; Widmer, Andreas F; SwissNoso (2020). Antimicrobial prophylaxis administration after umbilical cord clamping in cesarean section and the risk of surgical site infection: a cohort study with 55,901 patients. Antimicrobial Resistance and Infection Control, 9:201.

Abstract

BACKGROUND

The World Health Organization (WHO) recommends administration of surgical antimicrobial prophylaxis (SAP) in cesarean section prior to incision to prevent surgical site infections (SSI). This study aimed to determine whether SAP administration following cord clamping confers an increased SSI risk to the mother.

METHODS

Study design: Cohort.

SETTING

75 participating Swiss hospitals, from 2009 to 2018.

PARTICIPANTS

A total of 55,901 patients were analyzed.

MAIN OUTCOME MEASURES

We assessed the association between SAP administration relative to incision and clamping and the SSI rate, using generalized linear multilevel models, adjusted for patient characteristics, procedural variables, and health-care system factors.

RESULTS

SAP was administered before incision in 26'405 patients (47.2%) and after clamping in 29,496 patients (52.8%). Overall 846 SSIs were documented, of which 379 (1.6% [95% CI, 1.4-1.8%]) occurred before incision and 449 (1.7% [1.5-1.9%]) after clamping (p = 0.759). The adjusted odds ratio for SAP administration after clamping was not significantly associated with an increased SSI rate (1.14, 95% CI 0.96-1.36; p = 0.144) when compared to before incision. Supplementary and subgroup analyses supported these main results.

CONCLUSIONS

This study did not confirm an increased SSI risk for the mother in cesarean section if SAP is given after umbilical cord clamping compared to before incision.

Abstract

BACKGROUND

The World Health Organization (WHO) recommends administration of surgical antimicrobial prophylaxis (SAP) in cesarean section prior to incision to prevent surgical site infections (SSI). This study aimed to determine whether SAP administration following cord clamping confers an increased SSI risk to the mother.

METHODS

Study design: Cohort.

SETTING

75 participating Swiss hospitals, from 2009 to 2018.

PARTICIPANTS

A total of 55,901 patients were analyzed.

MAIN OUTCOME MEASURES

We assessed the association between SAP administration relative to incision and clamping and the SSI rate, using generalized linear multilevel models, adjusted for patient characteristics, procedural variables, and health-care system factors.

RESULTS

SAP was administered before incision in 26'405 patients (47.2%) and after clamping in 29,496 patients (52.8%). Overall 846 SSIs were documented, of which 379 (1.6% [95% CI, 1.4-1.8%]) occurred before incision and 449 (1.7% [1.5-1.9%]) after clamping (p = 0.759). The adjusted odds ratio for SAP administration after clamping was not significantly associated with an increased SSI rate (1.14, 95% CI 0.96-1.36; p = 0.144) when compared to before incision. Supplementary and subgroup analyses supported these main results.

CONCLUSIONS

This study did not confirm an increased SSI risk for the mother in cesarean section if SAP is given after umbilical cord clamping compared to before incision.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Infectious Diseases
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Public Health, Environmental and Occupational Health
Health Sciences > Microbiology (medical)
Health Sciences > Infectious Diseases
Health Sciences > Pharmacology (medical)
Language:English
Date:22 December 2020
Deposited On:15 Jan 2021 17:00
Last Modified:24 Jun 2024 01:43
Publisher:BioMed Central
ISSN:2047-2994
OA Status:Gold
Free access at:PubMed ID. An embargo period may apply.
Publisher DOI:https://doi.org/10.1186/s13756-020-00860-0
PubMed ID:33349269
  • Content: Published Version
  • Licence: Creative Commons: Attribution 4.0 International (CC BY 4.0)