DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20190288

Comparison of prophylactic versus regular use of antibiotics in elective major obstetrical and gynecological surgeries

Ramya Sreevarshni Shunmugha Sundharam, Hiremath P. B., Sankareswari R.

Abstract


Background: Surgical site infections better prevented by parenteral antibiotic in sufficient doses generally should be given before the operation which helps to achieve the therapeutic drug level both in the blood and related tissue during the operation. Ceftriaxone, when administered together as a prophylaxis can fulfil the above criteria of a good antibiotic. Thus, this study was planned to assess the efficacy of prophylactic antibiotic usage to that of regular antibiotics usage in patients undergoing elective surgeries.

Methods: This randomized controlled study was conducted in a tertiary care teaching hospital during the study period of June 2017 to April 2018 with 140 cases. Group A received a single dose of Injection Ceftriaxone 1g. Group B, received Injection Ceftriaxone 1 gm and Injection Metronidazole 500 mg for five days. The data was entered in excel sheet and analyzed using SPSS (Version 16).

Results: The mean age group in Group A and Group B was found to be 34.24±10.5 and 35.97±11.89, respectively. There was no statistical significance between group A and B for incidence of infection in the post-operative period and duration of hospital stay. The mean value in group A for duration of surgery was found to be 67.5±13.5 and in group B mean value was 72.1±14.9. (p value <0.05).

Conclusions: This study demonstrated that administration of prophylactic antibiotic rather than conventional antibiotic at caesarean and gynecological surgeries are not associated with significant difference in post-operative morbidities.


Keywords


Ceftriaxone, Prophylactic antibiotic, Surgical site infection

Full Text:

PDF

References


Mauermann WJ, Nemergut EC: The anesthesiologist’s role in the prevention of surgical site infections. Anesthesiol. 2006; 105:413-21.

Kirkland KB, Briggs JP, Trivette SL, Wilkinson WE, Sexton DJ. The impact of surgicalsite infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol. 1999;20(11):725-30.

Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. New Engl J Med. 1996;334(19):1209-16.

Fry DE. Surgical site infections and the surgical care improvement project (SCIP): evolution of national quality measures. Surg Infect. 2008;9(6):579-84.

Gaynes RP, Culver DH, Horan TC, Edwards JR, Richards C, Tolson JS, National Nosocomial Infections Surveillance System. Surgical site infection (SSI) rates in the United States, 1992–1998: the National Nosocomial Infections Surveillance System basic SSI risk index. Clinic Infect Dis. 2001;33(Supplement_2):S69-77.

Smaill F, Hofmeyr GJ. Antibiotic prophylaxis for cesarean section. Cochrane Database Syst Rev. 2002(3):CD000933.

Hawrylyshyn PA, Bernstein P, Papsin FR. Short-term antibiotic prophylaxis in high-risk patients following cesarean section. Am J Obstet Gynecol. 1983; 145(3):285-9.

Andrews WW, Hauth JC, Cliver SP, Savage K, Goldenberg RL. Randomized clinical trial of extended spectrum antibiotic prophylaxis with coverage for Ureaplasma urealyticum to reduce post-cesarean delivery endometritis. Obstet Gynecol. 2003;101(6):1183-9.

Andes DR, Craig WA. Cephalosporins. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia; PA: Churchill-Livingstone; Elsevier: 2009.

Anand NI, Parmar DM, Sukhlecha A. Comparison of combinations of ciprofloxacin-metronidazole and ceftriaxone-metronidazole in controlling operative site infections in obstetrics and gynecological surgeries: A retrospective study. J Pharmacol Pharmacotherapeut. 2011;2(3):170.

Munmun SA, Ara R, Chowdhury S, Sarkar MM, Chowdhury SB, Parvin N, et al. A Comparative Study between Single Dose of Ceftriaxone, Metronidazole and Gentamicine as a Prophylaxis versus Conventional Dose Antibiotic in Hysterectomy in BSMMU. J Bang College Physic Surg. 2015;32(3):149-52.

Nichols RL. Use of prophylactic antibiotics in surgical practice. Am J Med. 1981;70(3):686-92.

Anonymous. Antimicrobial prophylaxis in surgery; Med Lett Drugs Ther. 2016;58(1495):63-8.

Saha S, Ashrafuzzaman S. Impact of prophylactic use of antimicrobials in abdominal surgery in two tertiary level hospitals. Bang J Pharmacol. 2008;3(2).

Tahseen H, Naqvi KZ. Single Dose Prophylactic Antibiotic Versus Routine 5 Days Prophylactic Antibiotic in Prevention of Postoperative Infection in Elective, Clean Abdominal Gynecologic Surgeries. J Surgery Pakist (Int). 2014;19:3.

Dar LR, Fayaz F. Prophylactic antibiotics in elective major gynaecological surgery: Single perioperative dose vs multiple postoperative doses. Mother Child. 1999;37:51-3.

Crosby-Nwaobi RR, Faithfull S. High risk of urinary tract infections in post operative gynecology patients. A retrospective case analysis. Eur J Cancer Care. 2011;20:825-31.

Wald HL, Ma A, Bratzler DW, Kramer AM. Indwelling urinary catheter use in post operative period. Analysis of National Surgical infection prevention project data. Arch Surg. 2008;143:551-7.

Ansari N, Das CR, Ansari MA. Evaluation of Prophylactic Antibiotic in Caesarean Section. J Nepalgunj Med College. 2016;12(2):40-1.

Shakya A, Sharma J. Comparison of single versus multiple doses of antibiotic prophylaxis in reducing post-elective Caesarean section infectious morbidity. Kathmandu University Med J. 2010;8(2):179-84.

Farouk H, El Fatah AA, Gaber A. single dose prophylactic antibiotic before skin incision (suggested regimen prior to elective cs in al-zahraa hospital). AAMJ. 2011;9(1).

Nisa M, Talat N, Hassan I. Scope of surgical site infection. J Postgrad Med Inst. 2005;19:438-41.

Sadique I, Abid S, Aleem S, Anwar S, Hafeez M, Pasha MI, et al. Single dose prophylaxis in obstetrics and gynaecological surgeries. Annals King Edward Med Univers. 2009;15(4):176.

Lamont RF, Haynes SV. Prevention of infection following gynecological surgery: the evidence. In Complications in Gynecological Surgery 2008 (1-10). Springer, London.

Rouzi AA, Khalifa F, Ba’aqueel H, Al-Hamdan HS,Bondagji N. The routine use of cefazoline in caesarean section. Int J Obstet Gynecol. 2000;69:107-12.

Dimitrov A, Puneveska M, Dikov I, Nikolov A, Koctov I. Prophylaxis with tercef of infection related complications after caesarean section. Akush Ginekol. 2001;42:33-7.

Bagratee JS, Moodley J, Kleinschmidt I, Zawilski W. A randomised controlled trial of antibiotic prophylaxis in elective caesarean delivery. BJOG: Int J Obstet Gynaecol. 2001;108(2):143-8.