Antibiotic prophylaxis for caesarean section at a Ugandan hospital: a randomised clinical trial evaluating the effect of administration time on the incidence of postoperative infections
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Date
2015
Journal Title
Journal ISSN
Volume Title
Publisher
BMC pregnancy and childbirth
Abstract
Prophylactic antibiotics are used to prevent postoperative infections after caesarean section. Studies
have suggested that the timing of prophylaxis plays an important role. Over the years, the role of the
anaesthesiologist in the administration of prophylactic antibiotics has become prominent. Therefore, there is an
increasing need for anaesthesia providers to understand the rationale of antibiotic prophylaxis. We therefore sought
to compare the effect of antibiotics prophylaxis within 1 hour before skin incision and after skin incision on the
incidence of postoperative infections in patients undergoing caesarean section at Mulago Hospital.
Methods: We conducted a single-blind randomised clinical trial conducted at Mulago Hospital evaluating 464
patients undergoing emergency caesarean section. Patients were randomly assigned a group number that allocated
them to either arm of the study. They received the same prophylactic antibiotic according to their allotment, that
is, either within 1 hour before skin incision or after skin incision as per current standards of practice in Mulago Hospital.
They were followed up to detect infection up to 10 days postoperatively. The primary outcome was postoperative
infection. The data collected were analysed with STATA version 12 using univariate and bivariate analysis.
Results: The risk of overall postoperative infection was significantly lower when prophylaxis was given within an hour
before incision (RR O.77, 95% CI 0.62–0.97). We also found endometritis to be significantly reduced in the pre-incision
group (RR 0.62; 95% CI 0.39–0.99; P value 0.036).
Conclusions: Giving prophylactic antibiotics before skin incision reduces risk of postoperative infection, in particular of
endometritis.
Description
Keywords
Antibiotic prophylaxis, Caesarean section, Infection, Low-income setting
Citation
Dlamini, L. D., Sekikubo, M., Tumukunde, J., Kojjo, C., Ocen, D., Wabule, A., & Kwizera, A. (2015). Antibiotic prophylaxis for caesarean section at a Ugandan hospital: a randomised clinical trial evaluating the effect of administration time on the incidence of postoperative infections. BMC pregnancy and childbirth, 15(1), 1-7.DOI 10.1186/s12884-015-0514-3