Single vs. extended antibiotic for prevention of surgical infection in emergent cesarean delivery

Abstract

Objective: Emergency Cesarean Section (ECS) improves maternal and neonatal outcomes but can be associated with complications including Surgical Site Infections (SSI). Prophylactic antibiotics reduce SSIs but inappropriate use increases antibiotic resistance. The study aim was to assess single versus multiple-dose antibiotic prophylaxis for SSI prevention in a limited-resource setting. Methods: All patients undergoing ECS in a rural district hospital were assessed for eligibility from 2015 to 2016. Participants were randomized, Group A received one dose of 2 g Ampicillin 15 to 60 minutes before skin incision and Group B received 2 g prior to skin incision with additional 1g every 8 hours over 72 hours. Participants were followed for 30 days, Demographic and clinical data were collected by chart review and patient phone interviews were performed on Days 3, 7, 15 and 30. Results: Three hundred and one participants were analyzed (147 in Group A; 154 in Group B). There were 8 surgical site infections in Group A and 4 in Group B (p=0.089). The overall prevalence of surgical site infections was lower than expected (4.00%). Most of SSIs cases were diagnosed on day 7 (66.6% of all cases of SSI) and only 22.2% of cases were diagnosed at discharge (day 3). Only 1 additional case was diagnosed at day 15. Conclusion: Compliance to infection control measures can reduce the rate of SSIs. There was no significant difference between the use of a single vs multiple doses of prophylactic antibiotics in our study but the SSI rate was low.