|
|
 |
 |
 |
|
|
|||
|
||||
|
||||
Curious about your opinions about this articleFrom: GIN11153@aol.comSat Mar 17 20:39:34 2007
_http://www.obgynnews.com/article/PIIS0029743707701623/fulltext_ (http://www.obgynnews.com/article/PIIS0029743707701623/fulltext) SAN FRANCISCO — Preoperative prophylaxis with cefazolin more effectively prevents postcesarean infections than does intraoperative administration of the antibiotic, a prospective study has shown. Additionally, giving the drug prior to skin incision does not increase neonatal infectious morbidity or sepsis evaluation, Dr. Scott Sullivan reported at the annual meeting of the Society for Maternal-Fetal Medicine. The efficacy of single-dose antibiotic prophylaxis for reducing the risk of postcesarean infection is well established, “but controversy exists regarding the most effective timing of prophylaxis,†said Dr. Sullivan of the Medical University of South Carolina in Charleston. “It's common obstetrical practice in the United States to delay antibiotic prophylaxis for cesarean sections until the neonate is delivered, typically at the time of cord clamping.†Preoperative administration of antibiotics has been avoided “largely due to theoretical neonatal risks, including increased neonatal resistance, increased neonatal sepsis, and increased septic work-ups,†he said. In the current investigation of 357 women undergoing cesarean section, 175 were randomized to receive 1 g of cefazolin 15–60 minutes prior to skin incision and placebo at time of cord clamping and 182 received placebo prior to incision and 1 g of cefazolin at the time of cord clamping. Eight of the 357 patients were lost to follow-up after hospital discharge but were included in the final analysis, said Dr. Sullivan. The study participants were older than 18 years and most were actively in labor at the time of surgery, although some were not in labor but required surgery because of breech presentation or other indications, Dr. Sullivan said. Women with cephalosporin allergy were excluded from the study, as were those already on antibiotics and those requiring emergency cesarean surgery. There were no differences between the two groups with respect to maternal demographic or obstetric variables. Patients were followed for up to 6 weeks post partum for evidence of infectious morbidity. “Endomyometritis and wound infections were diagnosed using established clinical criteria, and other maternal infections were diagnosed via positive culture,†Dr. Sullivan said. An analysis of infectious morbidity showed significant decreases in total postcesarean infections and endomyometritis, as well as a trend toward decreased wound infections, in the preoperative prophylaxis group, compared with the intraoperative group, Dr. Sullivan said. Specifically, in the preoperative prophylaxis group, there were two cases of endomyometritis, five wound infections, and one additional infection. In the intraoperative prophylaxis group, 10 patients each experienced endomyometritis and wound infections, and 1 patient experienced an additional infection. Because the control group had a relatively higher number of medical complications and mean operative times, the investigators performed a precautionary logistic regression analysis to control for this effect. “The adjusted odds ratio was not significantly different,†Dr. Sullivan noted. In terms of neonatal outcomes, there were no differences in neonatal sepsis, neonatal septic work-ups, rates of neonatal intensive care unit or level 2 admissions, or total length of stay between the two groups. Although there were significantly fewer NICU admission days in the preoperative group, “this finding cannot be attributed to the prophylaxis timing without further investigation,†Dr. Sullivan said. “There were only two cases of early-onset neonatal sepsis—one in each group— and there was no evidence of different resistance patterns in any of the organisms,†Dr. Sullivan said. The generalizability of the study findings may be limited by the fact that the populations of both groups were more overweight, more likely to be diabetic, had more medical complications, and included more minorities than did a typical obstetric population. Additionally, “the cesarean sections were performed by or with resident surgeons of varying levels of experience, resulting in longer mean operative time and higher mean estimated blood loss than would have been expected,†Dr. Sullivan said. Gail Neuman RNC CPHW student midwife and student nurse practitioner certified high risk OB/OB legal consultant Perinatal Nurse Associates Santa Ana, CA
|
|
Return to
|
Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Thu Oct 2 04:56:04 2008 |
The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.