Pattern of prophylactic antibiotics usage in caesarean section: An observational study

Abstract

Background: Caesarean section is the most important factor associated with postpartum bacterial infections, with a infection rate reported to be 1-25%, which is 5-20 times higher than that of vaginal delivery. Materials & Methods: It was a prospective observational single centre study. The data was collected from the patient’s file in the nursing station within the hospital premises. The hospital was a tertiary care hospital, West Bengal. The prospective study was conducted at a tertiary care hospital with all pregnant women undergoing elective and emergency caesarean section. The study was designed to assess the type of antibiotics was used prophylactically before undergoing a caesarean section. Interval between the time of administration of antibiotic & time of delivery was assessed. Data on the use of antibiotic prophylaxis in caesarean sections was collected using a customized proforma. Other data included were indication for caesarean section, route of administration of antibiotics, type of antibiotics, dosage of antibiotics, time of incision, and duration of operation. All the methods were compared to Hospital protocol and NICE protocol. Results: The maximum no.of patients were administered the combination of inj. cefotaxime & inj. metronidazole that is 49.8%. The mean time interval between administration of antibiotic and delivery (mean± s.d.) of the patients was 44.99±16.83 minutes with range 5-90 minutes and the median was 45 minutes. Most of the time interval 209 (68.5%) were as per hospital protocol which was statistically significant (Z=5.79; p=0.0001). Conclusion: Antibiotic prophylaxis significantly reduces the postpartum infection rate & thus reduces maternal morbidity & mortality in caesarean section. In this study conducted at a tertiary care hospital, the prophylactic antibiotic usage data showed that combination of cefotaxime & metronidazole is most frequently used. The study describes that the usage of prophylactic antibiotic combination cefotaxime & metronidazole are most appropriate & have compliance with hospital protocol & NICE protocol.
Keywords: Antibiotic prophylaxis, postoperative infection, caesarean section, surgical site infection (SSI)