Antibiotic prophylaxis to prevent postoperative infectious morbidity in low-risk elective cesarean deliveries: a prospective randomized clinical trial

Abstract

Objective: To determine the effectiveness and cost of antibiotic chemoprophylaxis in reducing infectious morbidity in low-risk women undergoing elective cesarean delivery.

Methods: A prospective randomized clinical trial was performed at a single tertiary care center in Jinan, China between November 2012 and December 2013. Women were randomized to receive either antibiotic prophylaxis or no antibiotics prior to elective cesarean delivery at term. The infectious morbidity (fever, surgical site infection – SSI, endometritis and urinary tract infection), routine blood tests and hospital costs were measured.

Results: Total of 414 women were enrolled into the study; and 202 women received antibiotic chemoprophylaxis and 212 women received no antibiotics. Demographic and clinical characteristics were similar between the two groups. Total of one case in the treatment group and four case in the non-treatment group developed endometritis, giving the postoperative infection rate of 1.2%, which was not statistically significant between the two groups (χ² = 1.679, p = 0.195). The secondary outcomes were also not different between the two groups, except the costs of hospitalization, which was significantly higher in the treatment group (p < 0.001).

Conclusions: In low-risk women undergoing elective cesarean delivery at term, prophylactic antibiotics did not reduce the risk of postoperative infection, but significantly increased the cost of hospitalization.

Keywords:

• Antibiotics
• cesarean delivery
• prophylaxis
• surgical site infections

Acknowledgements

The authors would like to thank Dr. Errol R. Norwitz (Chairman, Department of Obstetrics & Gynecology, Tufts Medical Center, Boston, MA, USA) for his assistance in reviewing and editing the manuscript.

Declaration of interest

The authors report no declarations of interest.

Clinical Trial Number: ChiCTR-OPC-15005817 (see www.chictr.org.cn).