1
|
Yang M, Yuan F, Guo Y, Wang S. Efficacy of adding azithromycin to antibiotic prophylaxis in caesarean delivery: a meta-analysis and systematic review. Int J Antimicrob Agents 2022; 59:106533. [PMID: 35091057 DOI: 10.1016/j.ijantimicag.2022.106533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 11/19/2022]
Abstract
To explore the efficacy of adding azithromycin to antibiotic prophylaxis for patients undergoing caesarean delivery (CD), we conducted a statistical analysis of related randomised controlled trials (RCTs) and cohort studies in the existing literature. Studies that used the same study design and outcome indicators were included in our meta-analysis. We then carried out heterogeneity tests and effect quantity calculation. Our meta-analysis of RCTs showed that addition of azithromycin as prophylaxis in CD significantly reduced the risk of endometritis [relative risk (RR) = 0.62, 95% confidence interval (CI) 0.49-0.79; P < 0.0001] and wound infection (RR = 0.40, 95% CI 0.27-0.58; P < 0.00001). In addition, meta-analysis results of the cohort studies also confirmed the efficacy of azithromycin for endometritis (RR = 0.41, 95% CI 0.11-1.51; P = 0.18), wound infection (RR = 0.66, 95% CI 0.54-0.82; P = 0.0001) and composite infections outcome (RR = 0.80, 95% CI 0.66-0.96; P = 0.02). However, meta-analysis could not be used to evaluate the safety of adding azithromycin owing to inconsistencies in the outcome indicators used in different studies. Addition of azithromycin to antibiotic prophylaxis reduced the risk of surgical site infections in patients undergoing CD. However, additional subgroup studies involving non-elective CD and long-term follow-up studies on the safety of the offspring are required in the future.
Collapse
Affiliation(s)
- Mengqi Yang
- Department of Clinical Pharmacy, Jining No.1 People's Hospital, Jining Medical University, Jining 272002, China
| | - Fang Yuan
- Department of Clinical Pharmacy, Jining No.1 People's Hospital, Jining Medical University, Jining 272002, China
| | - Yujin Guo
- Department of Clinical Pharmacy, Jining No.1 People's Hospital, Jining Medical University, Jining 272002, China
| | - Shan Wang
- Department of Clinical Pharmacy, Jining No.1 People's Hospital, Jining Medical University, Jining 272002, China.
| |
Collapse
|
2
|
Wade-Vuturo A, Heaps S, Howard M, Goetzinger KR, Crimmins SD. Real-world implementation of a vaginal preparation policy prior to cesarean delivery. J Matern Fetal Neonatal Med 2022; 35:9430-9434. [PMID: 35168446 DOI: 10.1080/14767058.2022.2040476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Surgical site infections (SSIs) are a major source of morbidity and mortality for women who undergo cesarean section (c-section). SSIs following c-section include wound infection, infection of the endometrium (endometritis) and intra-abdominal infections. Perioperative interventions to prevent these infections continue to be studied, including the use of vaginal preparation prior to c-section. Although literature has shown that the use of vaginal preparation prior to c-section decreases the rate of SSI, real-world clinical data regarding effective implementation of these policies are lacking. The objectives of this study were to determine (1) if a vaginal preparation policy could be implemented in a real-world setting with a high compliance rate and (2) to identify factors led to differences in compliance with policy. STUDY DESIGN This was a secondary analysis of a retrospective cohort study designed to examine the incidence of SSI after c-section before and after the implementation of vaginal preparation policy. The primary outcomes included implementation rates of the vaginal preparation for the post policy cohort. Secondary outcomes included subgroup analysis of policy adherence based on time of day, urgency of delivery, membrane status, labor status, and maternal factors. RESULTS Overall adherence to the vaginal preparation policy was 87.2% of patients. Maternal factors did not impact the rate of policy adherence. 81.4% of patients undergoing c-section at night had vaginal prep completed compared to 89.9% of patients undergoing c-section during the day (p = .016). 63.8% of patients undergoing emergent c-section had vaginal prep completed, compared to 90.1% of patients undergoing non-emergent c-section (p < .001). Laboring patients were more likely to have vaginal preparation completed (143 (95.3%) vs. 225 (82.7%), p = .009). CONCLUSIONS Compliance with vaginal preparation policy was high. Patients who are undergoing evening deliveries and emergent deliveries are less likely to have vaginal preparation completed. Some of these differences are likely attributable to perceived urgency of the c-section. It is important that interventions are identified such as staff education and standardization of documentation to improve rates of policy adherence.
Collapse
Affiliation(s)
- Ashley Wade-Vuturo
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA.,University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sarah Heaps
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA.,University of Maryland School of Medicine, Baltimore, MD, USA
| | - Malina Howard
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA.,University of Maryland School of Medicine, Baltimore, MD, USA
| | - Katherine R Goetzinger
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA.,University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sarah D Crimmins
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA.,University of Maryland School of Medicine, Baltimore, MD, USA
| |
Collapse
|