Antibiotic prophylaxis practices in cesarean section with focus on timing – a Danish national survey

Main Article Content

Paul Bryde Axelsson
https://orcid.org/0000-0002-8403-0084
Azalie Caroline Riberholt Winther
Tine Dalsgaard Clausen
Ellen Christine Leth Løkkegaard

Abstract

Introduction: The last Danish survey in 1995 on the antibiotic prophylactic practices in cesarean section found that there was no consensus between delivery wards. Since then national guidelines have been established. We therefore wanted to see if clinical practice regarding antibiotic prophylaxis had become more uniform.


Methods: In February of 2019 the delivery wards in Denmark (n=21) were contacted to answer an online questionnaire regarding type and dose of antibiotic prophylaxis used, timing of the administration, and differences between elective and emergency cesarean section.


Results: All twenty-one wards applied a single dose of 1500 mg Cefuroxime, a 3rd generation cephalosporin. Three wards (14%) administered antibiotic prophylaxis after cord clamping and eighteen (86%) prior to clamping, with nine (43%) wards having changed practice during the last 10 years. Three wards recalled the precise year for the change, six wards gave an approximate range of years, and five wards did not remember. The exact timing of the antibiotic varied from 0-60 minutes prior to incision, with sixteen (76%) wards reporting giving antibiotics usually 0-30 minutes prior to and of those, eleven (52%) immediately prior. All wards had the same prophylactic antibiotics principles for emergency and elective cesarean sections.


Conclusion: Most wards adhere to national guideline recommendations, but recollection was imperfect as to when changes in practices were implemented. We suggest that current and previous guidelines from hospitals in Denmark be stored in a national database, or more preferably that a national cesarean birth registry be established, accounting for the frequent local changes and interpersonal differences in clinical practice.

Article Details

How to Cite
Antibiotic prophylaxis practices in cesarean section with focus on timing – a Danish national survey. (2023). Danish Journal of Obstetrics and Gynaecology, 1(1), 46-53. https://doi.org/10.56182/djog.v1i1.8
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Author Biographies

Paul Bryde Axelsson, Nordsjællands Hospital, Hillerød, Denmark

Department of Gynaecology and Obstetrics

Azalie Caroline Riberholt Winther, Nordsjællands Hospital, Hillerød, Denmark

Department of Obstetrics and Gynaecology

Tine Dalsgaard Clausen, Nordsjællands Hospital, Hillerød, Denmark

Department of Obstetrics and Gynaecology

Ellen Christine Leth Løkkegaard, Nordsjællands Hospital, Hillerød, Denmark

Department of Obstetrics and Gynaecology

How to Cite

Antibiotic prophylaxis practices in cesarean section with focus on timing – a Danish national survey. (2023). Danish Journal of Obstetrics and Gynaecology, 1(1), 46-53. https://doi.org/10.56182/djog.v1i1.8

References

Smaill FM, Grivell RM. Antibiotic prophy-laxis versus no prophylaxis for preventing infection after cesarean section. Cochrane Database Syst Rev 2014;10:CD007482.

Pedersen TK, Blaakaer J. Antibiotic prophylaxis in cesarean section. Acta Ob-stet Gynecol Scand 1996;75:537–9.

Lamont RF, Sobel JD, Kusanovic JP, et al. Current debate on the use of antibiotic prophylaxis for caesarean section. BJOG Int J Obstet Gynaecol 2011;118:193–201.

Bollig C, Nothacker M, Lehane C, et al. Prophylactic antibiotics before cord clamping in cesarean delivery: a system-atic review. Acta Obstet Gynecol Scand 2018;97:521–35.

Costantine MM, Rahman M, Ghulmiyah L, et al. Timing of perioperative antibiot-ics for cesarean delivery: a metaanalysis. Am J Obstet Gynecol 2008;199:301.e1-6.

National Institute for Health and Care Excellence. Cesarean Section Clinical Guideline. 2011;

Committee opinion no. 465: antimicrobi-al prophylaxis for cesarean delivery: tim-ing of administration. Obstet Gynecol 2010;116:791–2.

Gholitabar M, Ullman R, James D, et al. Caesarean section: summary of updated NICE guidance. BMJ 2011;343:d7108.

Daugaard P, Eidhammer A, Hansen KB, et al. Antibiotika. DSOG. [Internet]. 2012.Tilgået fra: http://gynobsguideline.dk/sandbjerg/120425%20ANTIBIOTIKA%20endelig%2025%204%2012.pdf

de Jonge SW, Gans SL, Atema JJ, et al. Timing of preoperative antibiotic prophy-laxis in 54,552 patients and the risk of surgical site infection: A systematic re-view and meta-analysis. Medicine (Bal-timore) 2017;96:e6903.

Mackeen AD, Packard RE, Ota E, et al. Timing of intravenous prophylactic anti-biotics for preventing postpartum infec-tious morbidity in women undergoing ce-sarean delivery. Cochrane Database Syst Rev 2014;12:CD009516.

Coker MO, Hoen AG, Dade E, et al. Spe-cific class of intrapartum antibiotics re-lates to maturation of the infant gut mi-crobiota: a prospective cohort study. BJOG Int J Obstet Gynaecol [Internet] 2019 [henvist 7 maj 2019];Tilgået fra: https://onlinelibrary.wiley.com/doi/abs/10.1111/1471-0528.15799

Classen DC, Evans RS, Pestotnik SL, et al. The timing of prophylactic administra-tion of antibiotics and the risk of surgi-cal-wound infection. N Engl J Med 1992;326:281–6.

Steinberg JP, Braun BI, Hellinger WC, et al. Timing of antimicrobial prophylaxis and the risk of surgical site infections: results from the Trial to Reduce Antimi-crobial Prophylaxis Errors. Ann Surg 2009;250:10–6.

Koch CG, Nowicki ER, Rajeswaran J, et al. When the timing is right: Antibiotic tim-ing and infection after cardiac surgery. J Thorac Cardiovasc Surg 2012;144:931-937.e4.

Swissnoso, Sommerstein R, Marschall J, et al. Antimicrobial prophylaxis admin-istration after umbilical cord clamping in cesarean section and the risk of surgical site infection: a cohort study with 55,901 patients. Antimicrob Resist Infect Control 2020;9:201.

Pinto-Lopes R, Sousa-Pinto B, Azevedo L. Single dose versus multiple dose of anti-biotic prophylaxis in caesarean section: a systematic review and meta-analysis. BJOG Int J Obstet Gynaecol 2017;124:595–605.

Mathew JL. Effect of maternal antibiotics on breast feeding infants. Postgrad Med J 2004;80:196–200.