Timing of prophylactic antibiotic use during elective caesarean section: a meta-analysis of randomised controlled trials

Abstract

Timing of prophylactic antibiotic use during elective caesarean section: a meta-analysis of randomised controlled trials Shi-Fu Hu1 , Ying-Ying Wang2 , Yan-Qing Wu2 , Qiong Yu3, * 1Obstetrics and Gynecology Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 Hubei, P. R. China 2 Family Planning Research Institute, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 Hubei, P. R. China 3 Reproductive Medicine Center, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, 430030 Hubei, P. R. China *Correspondence: cmuyuqiong@163.com (Qiong Yu) DOI:10.31083/j.ceog.2021.01.2182 This is an open access article under the CC BY 4.0 license (https://creativecommons.org/licenses/by/4.0/). Submitted: June 07, 2020 Revised: September 06, 2020 Accepted: September 09, 2020 Published: February 15, 2021 Perioperative antibiotic therapy is recommended to reduce the incidence of infection aȻter caesarean section. However, the optimal timing of prophylactic antibiotic administration in such cases remains controversial. With this meta-analysis, we aimed to evaluate the safety and eȞficacy of prophylactic antibiotic therapy before skin incision versus aȻter umbilical cord clamping in patients undergoingelectivecaesareansection. WesearchedthePubMed, EMBASE, Cochrane Library and Web of Science databases for randomised controlled trials (RCTs) published between January 1, 2000 and July 1, 2020. The 1101 initially identified references were narrowed to 10 RCTs involving 5020 women for the final analysis. BrieȠly, we determined that prophylactic antibiotic therapy before skin incision not only reduced the incidence of postpartum endometritis (relative risk (RR), 0.56; 95% confidence interval (CI), 0.34-0.92; P = 0.02), but also decreased the rate of total infectious morbidity (RR, 0.79; 95% CI, 0.64-0.98; P= 0.03) when compared to antibiotic therapy aȻter umbilical cord clipping. However, the two timings of antibiotic administration did not lead to significant diȞferences in the incidence of wound infection (RR, 0.73; 95% CI, 0.54-1.00; P = 0.05), maternal febrile morbidity (RR, 1.20; 95% CI, 0.67-2.14; P = 0.54), neonatal sepsis (RR = 0.65; 95% CI, 0.37-1.13; P = 0.13), septic workup (RR, 0.89; 95% CI, 0.67- 1.18; P= 1.00) or neonatal intensive care unit admission (RR, 0.87; 95% CI, 0.69-1.09; P = 0.23). In conclusion, the prophylactic administration of antibiotics before a skin incision is made for an elective caesarean section can significantly decrease the incidence of total infectious morbidity and postpartum endometritis. Keywords Elective caesarean section; Prophylactic antibiotic therapy; Timing; Randomised controlled trial; Meta-analysis