The risk of surgical site infection for mothers undergoing Caesarean section is not increased if surgical antibiotic prophylaxis (SAP) is given after umbilical cord clamping, compared with before incision, the results of a large prospective study show.
The study was due to be presented at the 2020 European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), which was cancelled due to the COVID-19 pandemic.
The World Health Organization (WHO) recommends administration of SAP in Caesarean section prior to incision to prevent surgical site infections (SSIs). However, SAP may disrupt babies’ developing gastrointestinal microbiome if given before umbilical cord clamping.
The study used data from the Swissnoso national SSI surveillance system (2009 to 2018), including mothers from 178 hospitals. The researchers included all Caesarean section patients given SAP agents cefuroxime, cefazolin, amoxicillin/clavulanate, or ceftriaxone, either within 60 minutes before incision or after clamping.
A total of 55,901 patients met the criteria: 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%) occurred before incision and 449 (1.7%) after clamping, with no statistically significant difference between the two methods, proving them to be equally safe. Supplementary and subgroup analyses supported these results.