Antimicrobial prophylaxis in caesarean section in Mulago Hospital: effect of administration time on incidence of post-operative infection: randomised clinical trial.

Abstract

Background: Prophylactic antibiotic administration is used to prevent post-surgical infection after caesarean section. Studies have suggested that the timing of prophylaxis plays an important role (Classen et al., 1992). There have been observed differences in outcome based on timing of administration. This is different depending on one group giving before skin incision another after skin incision. There is evidence that before skin incision has less incidence of post-operative infection without adverse neonatal outcome (Baaqeel & Baaqeel, 2013; Costantine et al., 2008). Over the years, the role of the anaesthesiologist in administering prophylactic antibiotics has come to prominence. There is increasing need for anaesthesia providers to understand the rationale of antimicrobial prophylaxis. Objective: To compare the effect of administration of prophylactic antibiotic within one hour before skin incision and administration after skin incision on the incidence of post-operative infection in caesarean section patients in Mulago Hospital. Design: A Single blinded randomised clinical trial done in Mulago Hospital on patients booked for caesarean section in labour ward theatre. The total sample size was 464. Procedure: Patients were randomly allocated a group number which placed them on either arms of the study. They received the same prophylactic antibiotic according to their allotment that is either within one hour before skin incision or after skin incision as per current standard of practice. They were followed up for post-operative infection up to10 days post operation. Data was entered with EpiData 3.1 and analyzed with STATA version 12. Results: A significant difference of 19.2% P value 0.022 was seen when comparing incidence of overall post operative infection being less when prophylaxis is given before skin incision. Endometritis was found to be significantly reduced when giving prophylaxis before skin incision P value 0.036, whereas the difference in incidence of wound infection was not significant. Conclusion: Giving prophylactic antibiotic before skin incision reduces incidence of post operative infection more especially endometritis.