The Iranian Journal of Obstetrics, Gynecology and Infertility

The Iranian Journal of Obstetrics, Gynecology and Infertility

Comparison of single dose of cefazolion versus single dose of cefazolin plus seven days cephalexin prophylactic therapy in postoperative infections after elective cesarean section and immediate adverse effect of antibiotic on infants

Document Type : Original Article

Authors
Shahnaz Ahmadi 1
Elham Rahmani 1
Kambiz Ahmadi 2
Banafshe Bahreman 3
1 Associate Professor, Department of Obstetrics and Gynecology, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran.
2 PhD student of Statistics, School of Science, Birjand University of Medical Sciences, Birjand, Iran.
3 Medical student, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran.
10.22038/ijogi.2016.7395
Abstract
Introduction:Cesarean section is a surgery which has an important role in decreasing maternal and fetal morbidity in some special deliveries. But, it should be noted that infection due to caesarean section is one of the major cause of maternal morbidity and antibiotics are effective in prophylaxis of infection. This study was performed with aim to determine the necessary duration of antibiotic therapy to reduce infections in cesarean section.
Methods: This randomized clinical trial, case-control study was performed on 204 women who were candidate for non-emergency cesarean section in Shohadaye Khalije Fars, Bushehr from 2014 to 2015. They were randomly divided to intervention (received single dose of prophylactic antibiotic after clamping umbilical cord) and control (received single dose of prophylactic antibiotic plus seven days of antibiotic after surgery) groups. They were assessed during 48 h after hospitalization in terms of fever, chills, cellulitis, discharge from incision site, uterine tenderness and they were also followed one week after discharge by referring to the clinic or hospital. Their infants were also evaluated during mother's hospitalization and also when referring by mother in terms of neonatal outcomes such as diarrhea, rash, and oral candidiasis. Data analysis was performed by SPSS software (version 18) and independent t-test, Chi-square and Fisher's exact test. PResults: There was no significant difference between the intervention and control groups in term of maternal complications including urinary tract infection by urine analysis (P=0.118), urine culture (P=0.180), metritis (P=0.622) and surgical site infection (P=0.076). Neonatal complications including diarrhea (P=0.621), rash (P=1).and oral candidiasis (P=1) has no significant difference between intervention and control groups.
Conclusion: Single dose antibiotic can be used instead of seven day regimen of antibiotics to reduce the infection in non-emergency cesarean sections.
Keywords
Antibiotic
Cesarean section
Infection
Morbidity
prophylaxis
  1. Vukomanovic P, Stefanovic M, Kutlesic R, Milosevic J, Golubovic Z, Stojiljkovic P, et al. Antibiotic prophylaxis single center experience. Acta Facul Med Naiss 2008; 25(2):61-7.
  2. Tajbakhsh S, Norouzi Esfahani M, Emaneini M, Motamed N, Rahmani E, Gharibi S. Identification of Streptococcus agalactiae by fluorescent in situ hybridization compared to culturing and the determination of prevalence of Streptococcus agalactiae colonization among pregnant women in Bushehr, Iran. BMC Infect Dis 2013; 13:420.
  3. Macharia MW. Antibiotic prophylaxis in elective cesarean section single dose compare to multiple dose antibiotics. [Doctor Thesis]. Nairobi, India: University of Nairobi Digital Repository; 2009. P. 238.
  4. Smaill F, Hofmeyr GJ. Antibiotic prophylaxis for cesarean section. Cochrane Database Syst Rev 2002; 3:CD000933.
  5. Mothilal M, Thivya R, Anjalakshi C, Ramesh A, Damodharan N. Comparison of effectiveness of azithromycin and cefazolin in post caesarean section infection. Pain 2013; 5(3):92-4.
  6. Navali N, Bastani P, Najafnejad B, Malah F. Comparing the effects of conventional surgery with resection of a layer of cutaneous and subcutaneous around the surgical incision on decreasing the rate of surgical wound infection and dehiscence in high risk patients operated for obstetrics and gynecologic conditions. Iran J Obstet Gynecol Infertil 2013; 16(58):1-7. (Persian).
  7. Olsen MA, Butler AM, Willer DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol 2008; 29(6):477–84.
  8. Smaill FM, Grivell RM. Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section. Cochrane Database Syst Rev 2014; 10:CD:007482.
  9. Gyte GM, Dou L, Vazquez JC. Different classes of antibiotics given to women routinely for preventing infection at caesarean section. Cochrane Database Syst Rev 2014; 11:CD008726.
  10. Sullivan SA, Smith T, Chang E, Hulsey T, Vandorsten JP, Soper D. Administration of cefazolin prior to skin incision is superior to cefazolin at cord clamping in preventing postcesarean infectious morbidity: a randomized, controlled trial. Am J Obstet Gynecol 2007; 196(5):455.e1-5.
  11. Baaqeel H, Baaqeel R. Timing of administration of prophylactic antibiotics for caesarean section: a systematic review and meta-analysis. BJOG 2013; 120(6):661–9.
  12. Dancer SJ. How antibiotics can make us sick: the less obvious adverse effects of antimicrobial chemotherapy. Lancet Infect Dis 2004; 4(10):611–9.
  13. Weng M, Walker WA. The role of gut microbiota in programming the immune phenotype. J Dev Orig Health Dis 2013; 4(3):203–14.
  14. Glasgow TS, Young PC, Wallin J, Kwok C, Stoddard G, Firth S, et al. Association of intrapartum antibiotic exposure and late-onset serious bacterial infections in infants. Pediatrics 2005; 116(3):696–702.
  15. Csaba G. Hormonal imprinting: phylogeny, ontogeny, diseases and possible role in present-day human evolution. Cell Biochem Funct 2007; 26(1):1–10.
  16. James R, Flint T. Cesarean delivery. In: Ronald S, Beth Y, Arthur F, Ingrid E, editors. Danforth's obstetrics and gynecology. 10th ed. Philadelphia: Lippincott Williams & Wilkins; 2008. P. 607-23.
  17. Khanem JA, Khair H, Benson R. Antibiotic prophylaxis for caesarean section at Tawam Hospital, UAE. Gulf Med J 2012; 1(1):15-8.
  18. Bhattachan K, Baral GN, Gauchan L. Single versus multiple dose regimen of prophylactic antibiotic in cesarean section. Nepal J Obstet Gynaecol 2013; 8(2):50-3.
  19. Shaheen S, Akhtar S. Comparison of single dose versus multiple doses of anitibiotic prophylaxis in elective caesarian. J Postgrad Med Inst 2014; 28(1):83-6.
  20. Zhang C, Zhang L, Liu X, Zhang L2, Zeng Z3, Li L, et al. Timing of antibiotic prophylaxis in elective caesarean delivery: a multi-center randomized controlled trial and meta-analysis. PLoS One 2015; 10(7):e0129434.
  21. Lyimo FM, Massinde AN, Kidenya BR, Konje ET, Mshana SE. Single dose of gentamicin in combination with metronidazole versus multiple doses for prevention of post-caesarean infection at Bugando Medical Centre in Mwanza, Tanzania, a randomized, equivalence, controlled trial. BMC Pregnancy Childbirth 2013; 13:123.
  22. Heesen M, Klöhr S, Rossaint R, Allegaert K, Deprest J, Van de Velde M, et al. Concerning the timing of antibiotic administration in women undergoing caesarean section: a systematic review and meta-analysis. BMJ Open 2013; 3(4):e002028.
The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 19, Issue 15
July 2016
Pages 1-7