Timing of perioperative antibiotics for cesarean delivery: a metaanalysis
Timing of perioperative antibiotics for cesarean delivery: a metaanalysis
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DOI：
10.1016/j.ajog.2008.06.077
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发表时间：
2008-09-01
影响因子：
9.8
通讯作者：
Saade, George R.
中科院分区：
文献类型：
--
作者：
Costantine, Maged M.;Rahman, Mahbubur;Saade, George R.
目的：本研究的目的是总结关于剖宫产围手术期抗生素使用时机的现有证据。研究设计：我们检索了文献，以比较剖宫产术前与脐带钳夹时给予剖宫产预防性抗生素的研究。仅纳入随机对照试验。 结果：术前给药可显着降低产后子宫内膜炎的风险（相对风险 [RR]，0.47；95% CI，0.26-0.85；P = .012）和总感染发病率（RR，0.50；95% CI，0.33-0.78；P = .002）。伤口感染风险呈降低趋势（RR，0.60；95% CI，0.30-1.21；P=.15）。术前给予抗生素并没有显着影响需要检查的疑似新生儿败血症（RR，1；95% CI，0.70-1.42）、确诊败血症（RR，0.93；95% CI，0.45-1.96）或新生儿重症监护病房入院（RR，1.07 95% CI，0.51-2.24）。随机对照试验之间不存在显着的异质性。 结论：有强有力的证据表明，在皮肤切口前而不是在脐带结扎后给予剖腹产抗生素预防，可以降低产后子宫内膜炎的发生率和总感染率，而不影响新生儿结局。
OBJECTIVE: The purpose of this study was to summarize the available evidence on timing of perioperative antibiotics for cesarean delivery.STUDY DESIGN: We searched the literature for studies that compare prophylactic antibiotics for cesarean delivery that are given before the procedure vs at cord clamping. Only randomized controlled trials were included.RESULTS: Preoperative administration significantly reduced the risk of postpartum endometritis (relative risk [RR], 0.47; 95% CI, 0.26-0.85; P = .012) and total infectious morbidity (RR, 0.50; 95% CI, 0.33-0.78; P = .002). There was a trend toward lower risk of wound infection ( RR, 0.60; 95% CI, 0.30-1.21; P=.15). Preoperative administration of antibiotics did not significantly affect suspected neonatal sepsis that requires a workup (RR, 1; 95% CI, 0.70-1.42), proven sepsis (RR, 0.93; 95% CI, 0.45-1.96), or neonatal intensive care unit admissions (RR, 1.07 95% CI, 0.51-2.24). There was no significant heterogeneity between the randomized controlled trials.CONCLUSION: There is strong evidence that antibiotic prophylaxis for cesarean delivery that is given before skin incision, rather than after cord clamping, decreases the incidence of postpartum endometritis and total infectious morbidities, without affecting neonatal outcomes.