Early online

A randomised trial comparing preoperative administration of single-dose kefazolin to kefazolin plus metronidazole as prophylactic antibiotics at caesarean section

Authors

  • R Lamfel Obstetrics and Gynaecology Department, Kalafong Provincial Tertiary Hospital, Pretoria, South Africa
  • L Snyman Obstetrics and Gynaecology Department, Kalafong Provincial Tertiary Hospital, Pretoria, South Africa
  • L Seopela Department of Obstetrics and Gynaecology, Faculty of Health Sciences,University of Pretoria, South Africa
  • G Jahn Obstetrics and Gynaecology Department, Kalafong Provincial Tertiary Hospital, Pretoria, South Africa
  • P Becker Biostatistics Unit, Faculty of Health Sciences, University of Pretoria, South Africa

DOI:

https://doi.org/10.7196/SAMJ.2024.v114i6.2232

Keywords:

Caesarean, Postpartum infection

Abstract

Background. Caesarean section is a life-saving procedure which is associated with high rates of maternal and neonatal complications. It has been estimated that globally, 29.7 million births occur by caesarean section annually. The risk of postpartum infection is estimated to be five to ten times higher compared to normal vaginal delivery. Pregnancy-related sepsis was listed as a top six cause of maternal mortality in the South African Saving Mothers report between 2017 and 2019. Multiple trials have been conducted in an attempt to optimise administration of prophylactic antibiotics in an effort to reduce postpartum infection and maternal sepsis, and current practice guidelines suggest that there is sufficient evidence that extended spectrum antibiotics, in combination with kefazolin, result in reduction of postpartum infections
Objectives. To investigate the effect of perioperative administration of kefazolin alone compared to kefazolin plus metronidazole on
postpartum infection in women undergoing caesarean section at Kalafong Provincial Tertiary Hospital.
Method. All patients undergoing emergency or elective caesarean section were randomised and then sequentially numbered in opaque sealed envelopes, which were placed in the caesarean section operating theatre. The intervention group received kefazolin and a sealed envelope with metronidazole. The control group received kefazolin and a sealed envelope with normal saline.
Results. A total of 57/1 010 patients (5.64%) had surgical site infections, of which 27 (5.33%) were in the control group, and 30 (5.96%)
were in the intervention group (p=0.66). Two patients in each arm (0.40% in the intervention arm and 0.39% in the control arm) underwent laparotomy procedures, while three women (0.60%) in the intervention arm and four women (0.79%) in the control arm underwent hysterectomy procedures. There were no statistically significant differences in all the measured secondary outcomes between the two groups.
Conclusion. The overall sepsis rate in this study was 5.64%. Postpartum infection is multifactorial and there are multiple factors that can be addressed in strengthening the sepsis care bundle. We do not recommend the addition of metronidazole to kefazolin as prophylaxis at caesarean section.

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Published

2024-05-16

Issue

Section

Research

How to Cite

1.
Lamfel R, Snyman L, Seopela L, Jahn G, Becker P. Early online: A randomised trial comparing preoperative administration of single-dose kefazolin to kefazolin plus metronidazole as prophylactic antibiotics at caesarean section. S Afr Med J [Internet]. 2024 May 16 [cited 2024 Jun. 15];114(5):e1081. Available from: https://samajournals.co.za/index.php/samj/article/view/2232

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