The study by Dr Rami Sommerstein, Bern University Hospital, Switzerland, and colleagues form Swissnoso, The Swiss National Centre for Infection Control showed the safety of antibiotics given to mothers after umbilical cord clamping in C-section.
Based on World Health Organization (WHO) recommendations admin-istration of surgical antimicrobial prophylaxis (SAP) in Caesarean section before incision to prevent surgical site infection (SSI), including endometritis, one of the most common types of SSIs.
The use of SAP may however distort the baby’s developing gastrointestinal microbiome if given before umbilical cord clamping. This present study that was to be presented at the European Congress of Clinical Microbiology of Infectious Diseases (ECCMID) analysed whether the administration of antibiotics before or after clamping of the umbilical cord affected the rate of SSI in mothers.
Current practice to administer antimicrobial prophylaxis before incision was introduced in 2012. WHO then later published guidelines in 2015, but was not picked up by all hospitals. This however allowed the comparison of outcomes between women who were given antibiotics before incision and after incision.
The study by Dr Rami and his team used data from the Swissnoso national SSI surveillance system from 2009 to 2018. The data include mothers from 178 hospitals and all C-section patients that were given SAP agents, cefuroxime, cefazolin, amoxicillin/ clavulanate or ceftriaxone. They were administered within 600 minutes before incision or after clamping.
The researchers assessed the association between SAP administration relative to incision and clamping and the SSI rate, using computer models. After adjusting for patient characteristics, procedural variables and healthcare system factors, 846 SSIs were documented. These cases include 379 occurring before incision and 449 after clamping, with no statistically significant difference between the two methods.
The authors concluded that, “The results of this large prospective study provide strong evidence that the risk of surgical site infection for the mother in Caesarean section is not increased if antibiotic prophylaxis is given after umbilical cord clamping, compared to before incision. Given the latest research on the potentially detrimental effects of early-life antimicrobial exposure, guidance regarding optimal SAP timing should be re-evaluated.” [APBN]