Comparative study of surgical site infection with or without post cesarean prophylactic oral antibiotics; a single-blinded randomized clinical trial

Introduction: Surgical site infection (SSI) is caused by cesarean section in the hospital and its prevalence in the studies is up to 16%. Objectives: This study aimed to compare the rate of infection in women undergoing cesarean section. Oral clindamycin and cefalexin were administered for 48 hours as prophylactic antibiotics. Patients and Methods: In this clinical trial study, women with emergency cesarean section were divided into two groups. Intervention was oral administration of cefalexin 500mg every 6 hours and clindamycin 300 mg every 6 hours for 48 hours. All participants were referred to the gynecology center on day 7–10, at the time of removal of the sutures, and within 30 days after cesarean section, to assess the presence or absence of wound infection after surgery during 30 days. Results: In this clinical trial study, 462 pregnant women undergoing cesarean section were enrolled in the intervention and control groups. Of 231 patients in the intervention group, 15 women (6.5%) had cesarean section infection (13 cases with superficial, and 2 cases with deep infection). In the control group, 45 cases (19.5%) had cesarean section infection (31 cases with superficial, 10 cases with deep, and 4 cases with developed pelvic infection) (P = 0.001). Age, pre-cesarean length of stay, pre-term incision, type of incision, discharge longer than 18 hours after cesarean section, and maternal diabetes were significantly different regarding cesarean section infection in both groups. The frequency of cesarean section infection was less in the intervention group (P <0.001). Conclusion: Administration of prophylactic antibiotic can have a significant role in reducing cesarean section infection. Trial Registration: Registration of trial protocol has been approved in Thailand registry of clinical trials (identifier: TCTR20201204002, http://www.clinicaltrials.in.th/index.php?tp=regtrials & menu=trialsearch & s-menu=fulltext & task=search & task2=view1 & id=7120, ethical code; IR.UMSU.REC.1397.323).

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PERBANDINGAN ANTARA PEMBERIAN ANTIBIOTIKA PROFILAKSIS PADA SEKSIO SESAR SESUAI ALUR KLINIS RSUP DR SARDJITO DENGAN ANTIBIOTIKA DOSIS MULTIPEL TERHADAP KEJADIAN INFEKSI LUKA OPERASI

Jurnal Kesehatan Reproduksi ◽

10.22146/jkr.35444 ◽

2016 ◽

Vol 3 (2) ◽

pp. 75

Author(s):

Ardian Rahmansyah ◽

Mohammad Hakimi ◽

Rukmono Siswishanto

Keyword(s):

Length Of Stay ◽

Cesarean Section ◽

Surgical Site Infection ◽

Clinical Pathway ◽

Intervention Group ◽

Group Versus ◽

Control Group ◽

Site Infection ◽

Short Term

Background: Clinical pathway recommend the use of short-term prophylaxis antibiotics for cesarean section. Long-term antibiotics or multiple doses was found in clinical practice. There are differences in the mode of administration and the number of doses administered at sardjito hospital.Objective: To determine the effectiveness of short-term antibiotic prophylaxis in cesarean section appropriate to clinical pathway in the prevention of surgical site infection (ssi), the incidence of fever, dysuria events, length of stay.Method: The study used randomized clinical trial. The study subjects who underwent cesarean section and meet the inclusion and exclusion criteria in the period July 2013 to January 2014 divided into an intervention group (n = 52) who received ampicillin 2 gram pre and post-cesarean section, and a control group (n = 54) who received ampicillin 2 gram pre cesarean section and 1 gram every 8 hours for 6 times. Observed on days 3 and 10 post-cesarean section. The primary outcomes assessed were the incidence of surgical wound infection based on the criteria of surgical site infection from Centers for Disease Controland Prevention. Secondary outcomes assessed were the incidence of fever, dysuria events, length of stay. Homogeneity analysis were conducted on subject. Outcome analysis performed bivariate with t test and chi squared test.Results and Discussion : A total of 106 subjects can be analyzed. SSI events in the intervention group at day 3 was 3.8% (n = 52) and control group was 1.84% (n = 54) with p>0.05 RR 2.077 (95% CI 0.194 to 22.219). SSI on day 10 of 7.7% (n = 52) in the intervention group versus 9.3% (n = 54) in controls with p<0.05 RR 0.831 (CI 95%, 0.236 to 2.924). Fever events on day 3 by 5.8% in the intervention group versus 3.7% incontrols with p>0.05 RR 1.558 (95% CI 0.271 to 8.948) and on day 10 was 3.8% versus 3.7 % with p>0.05 RR 1.038 (95% CI 0.152 to 7.102). Dysuria not found on day 3 and but on 10 found 5.8% in the intervention group versus 11.1% with p>0.05 RR 0.519 (IK95% 0.137 to 1.968). Length of stay after cesarean section for 3.21 ± 0.412 days in the intervention group and 3.26 ± 0.442 days in the control group with p>0.05 (95% CI -0.213 - 0.117).Conclusion: There is no significant difference in the incidence of surgical wound infections, the incidence of fever, dysuria, length of stay between short-term prophylaxis antibiotics ampicillin appropriate to clinical pathway and long-term or multiple doses prophylaxis antibiotics. Short term antibiotics prophylaxis are more efficiently with the same effectiveness in preventing outcomes research.Keywords: prophylaxis antibiotics, ampicillin, short term regimen, long term regimen, cesarean section, surgical site infection.

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COMPARATIVE STUDY OF PRE-CAESAREAN VAGINAL WASH WITH 5% POVIDONE – IODINE SOLUTION VERSUS NO WASH IN PREVENTING POSTOPERATIVE INFECTION.

10.36106/ijsr/8030301 ◽

2020 ◽

pp. 44-46

Author(s):

Sonali Deshpande ◽

Shrinivas Gadappa ◽

Dhanashree Lahane ◽

Sandeep Mannikatti

Keyword(s):

Surgical Site Infection ◽

Wound Infection ◽

Povidone Iodine ◽

Prophylactic Antibiotic ◽

Control Group ◽

Site Infection ◽

Iodine Solution ◽

Interventional Group ◽

Vaginal Wash ◽

Povidone Iodine Solution

Objective: To evaluate the efficacy of pre-cesarean vaginal wash using 5% Povidone Iodine solution on rate of post-cesarean section (CS) surgical site infection and compared with No swabbing. Method: A Prospective Randomized controlled Trial was conducted in department of Obstetrics and Gynecology in Government medical college, Aurangabad. In interventional group, vaginal swabbing with a gauze pieces impregnated with 5% Povidone Iodine solution was done for 30 seconds. The swabbing of vagina was not performed in cases assigned to control group, however the standard surgical preparation of abdomen was done in a usual manner for both group. All subject received prophylactic antibiotic cover. Collected data was complied in pre-designed proforma and analysis was done using SPSS 15. Result: The risk of post operative fever and wound infection was significantly reduced in interventional group. No measure difference was noted in seroma and composite wound infection. Also less duration of hospital stay in interventional group was noted. No adverse effect of use of Povidone iodine was reported in the interventional group. Conclusion: Vaginal swabbing with 5% Povidone-iodine pre- LSCS is inexpensive and simple intervention even for low resource setting to decrease surgical site infection.

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Effects of Combined Warmed Preoperative Forced-air and Warmed Perioperative Intravenous Fluids on Maternal Temperature During Cesarean Section: a prospective, randomized, controlled clinical trial

10.21203/rs.2.20668/v1 ◽

2020 ◽

Author(s):

tingting Ni ◽

Zhen-feng Zhou ◽

Bo He ◽

Qing-he Zhou

Keyword(s):

Clinical Trial ◽

Cesarean Section ◽

Thermal Comfort ◽

Core Temperature ◽

Intervention Group ◽

Control Group ◽

Intravenous Fluids ◽

Cesarean Sections ◽

The Core ◽

Forced Air

Abstract Background: Preventing the frequent perioperative hypothermia incidents that occur during elective caesarean deliveries would be beneficial. This trial aimed at evaluating the effect of preoperative forced-air warming alongside perioperative intravenous fluid warming in women undergoing cesarean sections under spinal anesthesia.Methods: We randomly allocated135 women undergoing elective cesarean deliveries to either the intervention group (preoperative forced-air and intravenous fluid warmings, n = 69) or the control group (no active warming, n = 66). The primary outcome measure was the change from the core baseline temperature to that at the end of the procedure. Secondary outcomes included thermal comfort scores, the incidences of shivering and hypothermia (<36℃), the core temperature on arrival at the post-anesthesia care unit, neonatal axillary temperature at birth, and Apgar scores.Results: Two-way repeated measures ANOVA revealed significantly different core temperature changes (from the pre-spinal temperature to that at the end of the procedure) between groups (F = 13.022, P <0.001). The thermal comfort scores were also higher in the intervention group than in the control group (F = 9.847, P = 0.002). The overall incidence of perioperative hypothermia was significantly lower in the intervention group than in the control group (20.6% vs. 51.6%, P <0.0001).Conclusions: Warming preoperative forced-air and perioperative intravenous fluids may prevent maternal hypothermia, reduce maternal shivering, and improve maternal thermal comfort for patients undergoing cesarean sections under spinal anesthesia.Trial registration: The study was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR1800019117) on October26, 2018. Keywords: Cesarean section, Spinal anesthesia, Warming

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Incision and Prediction of Risk Factors Related to Surgical Site Infection Following Cesarean Section in Chinese Women

10.20944/preprints202109.0436.v1 ◽

2021 ◽

Author(s):

Qiuxiang Huang

Keyword(s):

Risk Factors ◽

Cesarean Section ◽

Surgical Site Infection ◽

Pregnant Women ◽

Chinese Women ◽

Severe Infection ◽

Control Group ◽

Site Infection ◽

Gynecology And Obstetrics ◽

Group Data

Cesarean Section (CS) is one of the most frequently executed surgical procedures in gynecology and obstetrics. After a cesarean section, surgical site infection (SSI) increases hospital stay, lengthens maternal morbidity, and upsurges treatment costs. The current study determines the prevalence and risk factors for surgical site infection following cesarean section in China. A retrospective study was conducted on 23 cases of pregnant women who underwent cesarean section and incision severe infection and detection from March 2017 to January 2020 at Wuhan Maternal and Child Healthcare Hospital in China as the study group, and 20 cases of uninfected cesarean section during the same period were selected as the control group. Data were compared with the controls based on study variables and the presence of SSI. The mean age was 31±2.6. High fever and blood loss were observed in serous SSI-infected patients. The incidence rate of severe surgical site infection was 0.15 %. SSI was observed to be expected in pregnant women who had premature rupture of membrane before surgery (p < 0.001), who underwent postoperative antibiotic therapy (p < 0.001), and the patients who had gestational diabetes mellitus (p <0.001) and hematoma (p < 0.001) during surgery. Hence, following a cesarean section, surgical site infection is common. This research discovered several modifiable risk factors. SSI is associated with multifactorial rather than a single one. The development and strict implementation of a procedure by all health care practitioners can successfully reduce and prevent infection rates following cesarean section.

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Eremostachys laciniata as effective as rectal diclofenac suppository in cesarean section pain relief: A triple-blind controlled clinical trial

Journal of Endometriosis and Pelvic Pain Disorders ◽

10.1177/2284026519899010 ◽

2020 ◽

Vol 12 (1) ◽

pp. 26-34

Author(s):

Shabnam Mohammad Pour ◽

Sevil Hakimi ◽

Abbas Delazar ◽

Yousef Javad Zadeh ◽

Fatemeh Mallah

Keyword(s):

Clinical Trial ◽

Cesarean Section ◽

Intervention Group ◽

Massive Hemorrhage ◽

Control Group ◽

Controlled Clinical Trial ◽

Total Extract ◽

Significant Difference ◽

Healing Score ◽

Distress Scale

Background: Pain and distress are two common complications of cesarean section. Among complementary therapies, Eremostachys was introduced as a pain mitigator. This study aimed at investigating the effect of Eremostachys laciniata on cesarean section pain and distress. Materials and methods: This randomized clinical trial was conducted on 86 women who gave childbirth by cesarean section. The control group received 50 mg rectal diclofenac suppository every 8 h for 3 days, and the intervention group received 35 mg E. laciniata total extract suppository every 8 h up to three doses. Pain was measured with the Visual Analogue Scale at 8, 16, and 24 h after cesarean section. The Symptom Distress Scale was completed at 8 and 24 h after cesarean section. The Redness, Edema, Ecchymosis, Discharge, Approximation scale was completed 5 days after cesarean section. Findings: Pain score at 8, 16, and 24 h after surgery (15 min after intervention) was not significantly different between the intervention and control groups. The distress score 24 h after cesarean section showed a significant difference in favor of the control group according to Friedman’s test. There was a significant difference between the two groups in wound healing score, which indicated better efficacy of rectal diclofenac suppository than E. laciniata suppository. We assessed nausea, vomiting, headache, massive hemorrhage, and any type of anaphylactic reaction. No side events were observed in two groups. Conclusion: Rectal E. laciniata suppository could be introduced as a low-complication, appropriate, and effective medication in controlling pain and distress after cesarean section; more studies should be conducted on this matter.

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The effect of triclosan-coated sutures on the rate of surgical site infection after hip and knee arthroplasty: a double-blind randomized controlled trial of 2546 patients

The Bone & Joint Journal ◽

10.1302/0301-620x.100b3.bjj-2017-0247.r1 ◽

2018 ◽

Vol 100-B (3) ◽

pp. 296-302 ◽

Cited By ~ 22

Author(s):

A. P. Sprowson† ◽

C. Jensen ◽

N. Parsons ◽

P. Partington ◽

K. Emmerson ◽

...

Keyword(s):

Surgical Site Infection ◽

Knee Arthroplasty ◽

Controlled Trial ◽

Intervention Group ◽

Control Group ◽

Site Infection ◽

Double Blind ◽

Suture Group ◽

Double Blinded ◽

Complication Of Surgery

AimsSurgical site infection (SSI) is a common complication of surgery with an incidence of about 1% in the United Kingdom. Sutures can lead to the development of a SSI, as micro-organisms can colonize the suture as it is implanted. Triclosan-coated sutures, being antimicrobical, were developed to reduce the rate of SSI. Our aim was to assess whether triclosan-coated sutures cause a reduction in SSIs following arthroplasty of the hip and knee.Patients and MethodsThis two-arm, parallel, double-blinded study involved 2546 patients undergoing elective total hip (THA) and total knee arthroplasty (TKA) at three hospitals. A total of 1323 were quasi-randomized to a standard suture group, and 1223 being quasi-randomized to the triclosan-coated suture group. The primary endpoint was the rate of SSI at 30 days postoperatively.ResultsThe baseline characteristics of age, gender and comorbidities were well matched in the two groups. The rates of superficial SSI were 0.8% in the control group and 0.7% in the intervention group (p = 0.651), and when deep and superficial SSIs were combined the rates were 2.5% and 1.8 (p = 0.266). The length of stay in hospital and the rates of medical complications did not differ significantly between the groups (p = 1.000).ConclusionThis trial provided no evidence that the use of triclosan-coated sutures at THA and TKA leads to a reduction in the rate of SSI. Cite this article: Bone Joint J 2018;100-B:296–302.

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Perioperative Intranasal Mupirocin for the Prevention of Surgical-Site Infections: Systematic Review of the Literature and Meta-Analysis

Infection Control and Hospital Epidemiology ◽

10.1086/505453 ◽

2005 ◽

Vol 26 (12) ◽

pp. 916-922 ◽

Cited By ~ 103

Author(s):

Alexander J. Kallen ◽

Chad T. Wilson ◽

Robin J. Larson

Keyword(s):

Systematic Review ◽

Surgical Site Infection ◽

Low Cost ◽

Meta Analysis ◽

Intervention Group ◽

Surgical Site Infections ◽

Control Group ◽

Site Infection ◽

Before And After ◽

Intranasal Mupirocin

AbstractObjective:To review the evidence evaluating perioperative intranasal mupirocin for the prevention of surgical-site infections according to type of surgical procedure.Design:Systematic review and meta-analysis of published clinical trials.Setting:Studies included were either randomized clinical trial or prospective trials at a single institution that measured outcomes both before and after an institution-wide intervention (before-after trial). In all studies, intervention and control groups differed only by the use of perioperative intranasal mupirocin in the intervention group.Patients:Patients undergoing general or nongeneral surgery (eg, cardiothoracic surgery, orthopedic surgery, and neurosurgery).Main Outcome Measure:Risk of surgical-site infection following perioperative intranasal mupirocin versus usual care.Results:Three randomized and four before-after trials met the inclusion criteria. No reduction in surgical-site infection rate was seen in randomized general surgery trials (summary estimates: 8.4% in the mupirocin group and 8.1% in the control group; relative risk [RR], 1.04; 95% confidence interval [CI95], 0.81 to 1.33). In nongeneral surgery, the use of mupirocin was associated with a reduction in surgical-site infection in randomized trials (summary estimates: 6.0% in the mupirocin group and 7.6% in the control group; RR, 0.80; CI95, 0.58 to 1.10) and in before-after trials (summary estimates: 1.7% in the mupirocin group and 4.1% in the control group; RR, 0.40; CI95, 0.29 to 0.56).Conclusions:Perioperative intranasal mupirocin appears to decrease the incidence of surgical-site infection when used as prophylaxis in nongeneral surgery. Given its low risk and low cost, use of perioperative intranasal mupirocin should be considered in these settings.

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Incidence, risk factors and management of post cesarean section surgical site infection (SSI) in a tertiary hospital in Egypt: a five year retrospective study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-04054-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Khaled Gomaa ◽

Ahmed R. Abdelraheim ◽

Saad El Gelany ◽

Eissa M. Khalifa ◽

Ayman M. Yousef ◽

...

Keyword(s):

Risk Factors ◽

Retrospective Study ◽

Mortality Rate ◽

Cesarean Section ◽

Surgical Site Infection ◽

Significant Risk ◽

Tertiary Hospital ◽

Control Group ◽

Site Infection ◽

Incidence Risk

Abstract Background Surgical site infection (SSI) is one of the commonest complications following cesarean section (CS) with a reported incidence of 3–20%. SSI causes massive burdens on both the mother and the health care system. Moreover, it is associated with high maternal morbidity and mortality rate of up to 3%. This study aims to determine the incidence, risk factors and management of SSI following CS in a tertiary hospital. Methods This was an observational case control retrospective study which was conducted at Minia maternity university hospital, Egypt during the period from January 2013 to December 2017 (Five years). A total of 15,502 CSs were performed during the studied period, of these, 828 cases developed SSI following CS (SSI group). The control group included 1500 women underwent cesarean section without developing SSI. The medical records of both groups were reviewed regarding the sociodemographic and the clinical characteristics. Results The incidence of SSI post-cesarean section was 5.34%. Significant risk factors for SSI were; chorioamnionitis (adjusted odds ratio (AOR) 4.51; 95% CI =3.12–6.18), premature rupture of membranes (PROM) (AOR 3.99; 95% CI =3.11–4.74), blood loss of > 1000 ml (AOR 2.21; 95% CI =1.62–3.09), emergency CS (AOR 2.16; 95% CI =1.61–2.51), duration of CS of > 1 h (AOR 2.12; 95% CI =1.67–2.79), no antenatal care (ANC) visits (AOR 2.05; 95% CI =1.66–2.37), duration of labor of ≥24 h (AOR 1.45; 95% CI =1.06–2.01), diabetes mellitus (DM) (AOR 1.37; 95% CI =1.02–2.1 3), obesity (AOR 1.34; 95% CI =0.95–1.84), high parity (AOR 1.27; 95% CI = 1.03–1.88), hypertension (AOR 1.19; 95% CI = 0.92–2.11) and gestational age of < 37 wks (AOR 1.12; 95% CI = 0.94–1.66). The mortality rate due to SSI was 1.33%. Conclusions The obtained incidence of SSI post CS in our study is relatively lower than other previous studies from developing countries. The development of SSI is associated with many factors rather than one factor. Management of SSI is maninly medical but surgical approach may be needed in some cases. Registration Local ethical committee (Registration number: MOBGYN0040).

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Comparative study on prophylactic antibiotic versus empirical antibiotic in prevention of surgical site infection

Journal of Drug Delivery and Therapeutics ◽

10.22270/jddt.v9i2.2344 ◽

2019 ◽

Vol 9 (2) ◽

pp. 9-13

Author(s):

S Rajarajan ◽

T.H. Sreelekshmi Devi ◽

Neeshma Mariam Simon ◽

K.R. Navin Shankar ◽

V. Ganesan

Keyword(s):

Single Dose ◽

Comparative Study ◽

Surgical Site Infection ◽

Hospital Stay ◽

Prophylactic Antibiotic ◽

Operative Therapy ◽

Prophylactic Antibiotics ◽

Control Group ◽

P Value ◽

Site Infection

The main aim of the study was to comparative study of single dose prophylactic antibiotic versus empirical postoperative antibiotics in prevention of surgical site infection. The study was a prospective observational study conducted over a period of 8months. A total of 100 number of surgery cases were selected randomly, to groups of 50 each. The study group received a single dose of antibiotic preoperatively while the control group received 3 to 5 days of empirical antibiotic therapy. Data analysis and statistical analysis was done with the help of graph pad prism trial version software. Student t test was carried out for paired analysis to find P value. There was no significant association of surgical site infection, grades of infection, and other complications. The hospital stay of patients, cost to the patients, and number of antibiotics used in patients were significantly more. The single dose prophylactic antibiotics are better than empirical post operative therapy in reducing the hospital stay and hospital cost to patients. Since the complete eradication of surgical site infection is not possible, only the reduction in infection rate can be achieved to a minimal level. Keywords: Prophylactic antibiotics, surgical site infection, surgical complications, post operative antibiotics.

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Effects of Combined Warmed Preoperative Forced-air and Warmed Perioperative Intravenous Fluids on Maternal Temperature During Cesarean Section: a prospective, randomized, controlled clinical trial

10.21203/rs.2.20668/v2 ◽

2020 ◽

Author(s):

tingting Ni ◽

Zhen-feng Zhou ◽

Bo He ◽

Qing-he Zhou

Keyword(s):

Clinical Trial ◽

Cesarean Section ◽

Thermal Comfort ◽

Spinal Anesthesia ◽

Intervention Group ◽

Control Group ◽

Intravenous Fluids ◽

Cesarean Sections ◽

The Core ◽

Forced Air

Abstract Background: Preventing the frequent perioperative hypothermia incidents that occur during elective caesarean deliveries would be beneficial. This trial aimed at evaluating the effect of preoperative forced-air warming alongside perioperative intravenous fluid warming in women undergoing cesarean sections under spinal anesthesia. Methods: We randomly allocated135 women undergoing elective cesarean deliveries to either the intervention group (preoperative forced-air and intravenous fluid warmings, n = 69) or the control group (no active warming, n = 66). The primary outcome measure was the change from the core baseline temperature to that at the end of the procedure. Secondary outcomes included thermal comfort scores, the incidences of shivering and hypothermia (<36℃), the core temperature on arrival at the post-anesthesia care unit, neonatal axillary temperature at birth, and Apgar scores. Results: Two-way repeated measures ANOVA revealed significantly different core temperature changes (from the pre-spinal temperature to that at the end of the procedure) between groups ( F = 13.022, P <0.001). The thermal comfort scores were also higher in the intervention group than in the control group ( F = 9.847, P = 0.002). The overall incidence of perioperative hypothermia was significantly lower in the intervention group than in the control group (20.6% vs. 51.6%, P <0.0001). Conclusions: Warming preoperative forced-air and perioperative intravenous fluids may prevent maternal hypothermia, reduce maternal shivering, and improve maternal thermal comfort for patients undergoing cesarean sections under spinal anesthesia. Trial registration: The study was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR1800019117) on October26, 2018. Keywords: Cesarean section, Spinal anesthesia, Warming

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