Antimicrobial Prophylaxis for Cesarean Delivery Before Skin Incision
Antimicrobial Prophylaxis for Cesarean Delivery Before Skin Incision
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DOI：
10.1097/aog.0b013e3181b490f1
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发表时间：
2009-09-01
影响因子：
7.2
通讯作者：
Wiesenfeld, Harold C.
中科院分区：
文献类型：
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作者：
Owens, Stephanie M.;Brozanski, Beverly S.;Wiesenfeld, Harold C.
目的：评价全院范围内改变剖宫产抗菌药物预防时机对母婴感染的影响。方法：2004年11月，我所制定指南，建议剖宫产应在皮肤切开前使用抗菌药物预防，而不是在脐带夹闭后使用。我们回顾了两个时期的所有剖腹产。第1组在脐带夹闭后给予抗生素治疗(2002年1月至2004年11月)。第2组在皮肤切开前(2005年6月至2007年8月)应用抗生素。结果：第1组剖宫产4 229例，第2组4 781例。与脐带夹闭后预防性应用抗菌药物组比较，切皮前预防性应用抗菌药物组产后子宫内膜炎发生率(2.2%)和伤口感染发生率(2.5%)均较低(3.6%)。经多因素Logistic回归分析，皮肤切开前预防抗菌药物仍与子宫内膜炎(优势比[OR]0.61，95%可信区间[CI]0.47~0.79)和伤口感染(OR[0.70，95%CI 0.55~0.90])的低发生率相关。皮肤切开前预防抗菌药物对新生儿感染率及新生儿评分无不良影响。结论：皮肤切开前预防抗菌药物与夹脐带后相比，可降低母体感染率，对新生儿感染无影响。剖宫产的抗菌预防应在皮肤切开之前进行，这与外科抗菌预防的基本原则一致。(Obstet Gyneol 2009；114：573-9)
OBJECTIVE: To estimate the effect of a hospital-wide change in the timing of antimicrobial prophylaxis in cesarean deliveries on maternal and neonatal infections.METHODS: In November 2004, our institution instituted guidelines recommending that the administration of antimicrobial prophylaxis for cesarean delivery be administered before skin incision rather than after umbilical-cord clamping. We reviewed all cesarean deliveries from two time periods. Group 1 received antibiotics after umbilical-cord clamping Ouly 2002 to November 2004). Group 2 received antibiotics before skin incision (June 2005 to August 2007). Rates of maternal and neonatal infectious complications were compared between groups.RESULTS: There were 4,229 cesarean deliveries in group 1 and 4,781 cesarean deliveries in group 2. Compared with women receiving antimicrobial prophylaxis after umbilical-cord clamping, those administered antimicrobial prophylaxis before skin incision had lower rates of postpartum endometritis (2.2% compared with 3.9%) and wound infection (2.5% compared with 3.6%). After multivariable logistic regression, antimicrobial prophylaxis before skin incision remained associated with lower rates of endometritis (odds ratio [OR] 0.61, 95% confidence interval [CI] 0.47-0.79) and wound infection (OR 0.70, 95% CI 0.55-0.90). Antimicrobial prophylaxis before skin incision had no adverse effect on neonatal infection rates or on the evaluation of the neonate.CONCLUSION: Antimicrobial prophylaxis before skin incision, compared with after cord clamping, resulted in lower rates of maternal infections and had no effect on neonatal infections. Antimicrobial prophylaxis for cesarean delivery should occur before skin incision, consistent with basic tenets of surgical antimicrobial prophylaxis. (Obstet Gynecol 2009;114:573-9)