The researchers conducted a study aimed to determine whether surgical antimicrobial prophylaxis administration following cord clamping confers an increased surgical site infections risk to the mother.
They found that there could be a possibility of an increased SSI risk for the mother in cesarean section if SAP is given after umbilical cord clamping compared to before incision.
The study is published in the Journal of Antimicrobial Resistance & Infection Control.
The World Health Organization (WHO) recommends administration of surgical antimicrobial prophylaxis (SAP) in the cesarean section prior to incision to prevent surgical site infections (SSI). Recent data, including a large randomized trial, from general and cardiac surgery, showed that administration of SAP very close to incision was not associated with an increased risk of SSI. The time interval between the incision and cord clamping is around 2–8 min, a very short period to assume a huge difference in the risk of SSI between the two strategies.
Therefore, Rami Sommerstein and colleagues from the Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland conducted the present study to determine whether SAP administration following cord clamping confers an increased SSI risk to the mother.
The authors carried out a cohort study which included a total of 55,901 patients from 75 participating Swiss hospitals. The primary outcome was measured as 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.
SAP was administered before incision in 26′405 patients (47.2%) and after clamping in 29,496 patients (52.8%).
The following results were noted-
a. 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).
b. 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.
c. Supplementary and subgroup analyses supported these main results.
Therefore, the authors concluded that "This study did not confirm an increased SSI risk for the mother in the cesarean section if SAP is given after umbilical cord clamping compared to before incision."
For further reference log on to:
Rami Sommerstein, Jonas Marschall, Andrew Atkinson, Daniel Surbek, Maria Gloria Dominguez-Bello, Nicolas Troillet, Andreas F. Widmer. Antimicrobial prophylaxis administration after umbilical cord clamping in cesarean section and the risk of surgical site infection: a cohort study with 55,901 patients. Antimicrobial Resistance & Infection Control, 2020; 9 (1) DOI: 10.1186/s13756-020-00860-0