Rami Sommerstein1,2, Jonas Marschall3,4, Andrew Atkinson3, Daniel Surbek5,6, Maria Gloria Dominguez-Bello7, Nicolas Troillet4,8, Andreas F Widmer9,10. 1. Department of Infectious Diseases, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland. rami.sommerstein@extern.insel.ch. 2. Swissnoso, National Center for Infection Control, Bern, Switzerland. rami.sommerstein@extern.insel.ch. 3. Department of Infectious Diseases, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland. 4. Swissnoso, National Center for Infection Control, Bern, Switzerland. 5. Department of Obstetrics and Gynaecology, Bern University Hospital, University of Bern, Bern, Switzerland. 6. Swiss Society of Obstetrics and Gynaecology, Bern, Switzerland. 7. Department of Biochemistry and Microbiology, Rutgers School of Environmental and Biological Science, New Brunswick, NJ, USA. 8. Service of Infectious Diseases, Central Institute, Valais Hospitals, Sion, Switzerland. 9. Swissnoso, National Center for Infection Control, Bern, Switzerland. andreas.widmer@usb.ch. 10. Department of Infectious Diseases, University Hospital Basel, Basel, Switzerland. andreas.widmer@usb.ch.
Abstract
BACKGROUND: The World Health Organization (WHO) recommends administration of surgical antimicrobial prophylaxis (SAP) in cesarean section prior to incision to prevent surgical site infections (SSI). This study aimed to determine whether SAP administration following cord clamping confers an increased SSI risk to the mother. METHODS: Study design: Cohort. SETTING: 75 participating Swiss hospitals, from 2009 to 2018. PARTICIPANTS: A total of 55,901 patients were analyzed. MAIN OUTCOME MEASURES: We assessed the association between SAP administration relative to incision and clamping and the SSI rate, using generalized linear multilevel models, adjusted for patient characteristics, procedural variables, and health-care system factors. RESULTS: SAP was administered before incision in 26'405 patients (47.2%) and after clamping in 29,496 patients (52.8%). Overall 846 SSIs were documented, of which 379 (1.6% [95% CI, 1.4-1.8%]) occurred before incision and 449 (1.7% [1.5-1.9%]) after clamping (p = 0.759). The adjusted odds ratio for SAP administration after clamping was not significantly associated with an increased SSI rate (1.14, 95% CI 0.96-1.36; p = 0.144) when compared to before incision. Supplementary and subgroup analyses supported these main results. CONCLUSIONS: This study did not confirm an increased SSI risk for the mother in cesarean section if SAP is given after umbilical cord clamping compared to before incision.
BACKGROUND: The World Health Organization (WHO) recommends administration of surgical antimicrobial prophylaxis (SAP) in cesarean section prior to incision to prevent surgical site infections (SSI). This study aimed to determine whether SAP administration following cord clamping confers an increased SSI risk to the mother. METHODS: Study design: Cohort. SETTING: 75 participating Swiss hospitals, from 2009 to 2018. PARTICIPANTS: A total of 55,901 patients were analyzed. MAIN OUTCOME MEASURES: We assessed the association between SAP administration relative to incision and clamping and the SSI rate, using generalized linear multilevel models, adjusted for patient characteristics, procedural variables, and health-care system factors. RESULTS:SAP was administered before incision in 26'405 patients (47.2%) and after clamping in 29,496 patients (52.8%). Overall 846 SSIs were documented, of which 379 (1.6% [95% CI, 1.4-1.8%]) occurred before incision and 449 (1.7% [1.5-1.9%]) after clamping (p = 0.759). The adjusted odds ratio for SAP administration after clamping was not significantly associated with an increased SSI rate (1.14, 95% CI 0.96-1.36; p = 0.144) when compared to before incision. Supplementary and subgroup analyses supported these main results. CONCLUSIONS: This study did not confirm an increased SSI risk for the mother in cesarean section if SAP is given after umbilical cord clamping compared to before incision.
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