Cesarean Antimicrobial Prophylaxis: Prior to Incision or Following Cord Clamping?
BACKGROUND AND PURPOSE:
Based on multiple meta-analyses, most recommendations call for administration of surgical antimicrobial prophylaxis (SAP) prior to cesarean incision to prevent surgical site infection (SSI)
However, these studies have significant limitations including data from low as well as high income regions and did not necessarily exclude women with preexisting infections
Data from recent literature (non-obstetric) did not demonstrate a difference in SSI based on pre vs post incision administration, as long as medication was provided close to incision time
Sommerstein et al. (Antimicrobial Resistance & Infection Control, 2020) assessed whether SAP administration following cord clamping conferred an increased SSI risk vs earlier timing
Prospective, multicenter cohort study (2009 to 2018)
Swiss National Surveillance Program
Pregnant women undergoing cesarean delivery
Exclusion: Preexisting maternal infections | SAP was not applied within 60 min before/after incision | Single SAP agent was not cefuroxime, cefazolin, amoxicillin/clavulanate, or ceftriaxone
Timing of SAP administration relative to incision and clamping
Association between the exposure and primary outcome was assessed using generalized linear multilevel models, adjusted for covariates such as characteristics, procedural variables, and health-care system factors
Post-discharge surveillance: 30 days
55,901 pregnant patients
SAP administered before incision: 47.2%
SAP administered after clamping: 52.8%
There was no difference in the incidence of SSI between the two groups
Before incision: 1.6% (95% CI, 1.4 to 1.8%)
After clamping: 1.7% (95% CI, 1.5 to 1.9%)
Adjusted odds ratio 1.14 (95% CI, 0.96 to 1.36); P = 0.144
There was no increased risk for SSI when surgical antimicrobial prophylaxis was administered after clamping, compared to before incision
Exact timing of clamping not available | Authors feel sufficient evidence that ‘after clamping’ based on peak timing of after incision dosing (5 to 10 minutes)
Patient comorbidities and skin prep procedures not reported in this database | BMI available iin only 40% of patients
The authors state
The results of this large prospective study provide evidence that the risk of surgical site infection for the mother in cesarean section is not increased if antimicrobial prophylaxis is given after umbilical cord clamping
This could be beneficial for the neonate’s developing microbiome
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
NOT ENOUGH CME HOURS
It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan