Deepamangalam, M (2013) Comparison of prophylactic Versus Regular use of antibiotic in caesarean section. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: Caesarean section is the most important risk factor for puerperal infection. Infectious complications following surgery are significant cause of morbidity and mortality. These include post-partum fever, urinary tract infection, respiratory infection, wound infection, vaginal infections and sepsis. All these complications in turn lead to increased usage of antibiotics, prolonged hospital stay, increased health costs and development of resistance to these antibiotics. Women who undergo caesarean section are at 5 to 20 fold increased risk of these infectious complications when compared to normal vaginal delivery. The present study is to evaluate the effectiveness of prophylactic antibiotic in reducing the infectious morbidity, mortality as well as effectiveness in reducing duration and cost of hospitalization. AIM OF STUDY: To compare the effectiveness of prophylactic antibiotics over regular postoperative antibiotic usage in preventing post-operative morbidity in terms of fever, urinary tract infection, wound sepsis, vaginal infection in patients undergoing both elective and emergency clean caesarean section. MATERIALS AND METHODS: The study was conducted at the Institute of Social Obstetrics, Government Kasturba Gandhi Hospital, Attached to Madras Medical College, Chennai. This was an interventional study / Prospective Study. The study was conducted for a period of 1 year starting from January 2012 to December 2012. The study group consisted of 1000 patients selected after considering the exclusion criteria and inclusion criteria. INCLUSION CRITERIA: 1) Women booked and immunized at KGH, 2) Women who had regular ante natal visits, 3) Women undergoing elective and emergency clean caesarean section (not in labor for >6 hrs), 4) Antenatal period uneventful, 5) Low risk antenatal mothers without any preexisting medical illness. EXCLUSION CRITERIA : 1) Referral cases, 2) Premature Rupture of Membranes > 12 hrs, 3) Meconium stained liquor, 4) Associated medical complications, 5) Pre-existing infection, 6) Anemia, 7) Intra operative blood loss > 2 liters, 8) Operative period lasting >3 to 4 hrs, 9) First visit to KGH without any previous records. The above 1000 patients were divided randomly into two groups of five hundred patients. Group -1 patients received Injection Cefotaxime 2 gms single dose intravenous stat at the time of cord clamping during caesarean section. These patients were not prescribed any post-operative antibiotics. Group- 2 patients received no prophylactic antibiotics. They were given postoperative antibiotics Inj.Cefotaxime 1gm intravenous twice daily for 5 days. SUMMARY : 1) 500 cases were allotted under group 1 and they received Inj.Cefotaxime 2 gms i.v at the time of cord clamping as prophylaxis. 2) 500 cases allotted under group 2 received only post- operative antibiotic Inj. Cefotaxime 1 gm i.v twice daily for 5 days. The antibiotic was started 4 to 6 hrs after surgery. 3) Of the total 1000 patients who underwent caesarean section, almost 926 were emergency caesarean and about 50 % were repeat sections. 4) Incidence of febrile morbidity in group 1 was 3% compared to 10% in group 2. Of the total 1000 patients studied, 6.5% developed fever, of which 23.1% belonged to group1 and 73.9% belonged to group 2. The ‘p’ value was found to be less than 0.01 which is statistically significant. 5) Incidence of UTI was 1.6% patients in group 1 and 7% in group 2. Of the total patients under study, 4.3% developed urinary tract infection, of which 18.6% belonged to group 1 and 81.4 % belonged to group 2. ‘p’ value was found to be less than 0.01 and it is statistically significant. 6) Incidence of wound infection in group 1 was 1.4% and 9% in group 2. The 'p’ value was calculated to be less than 0.01 and is statistically significant. 7) Respiratory tract infection and vaginal infection were almost absent in group1 and in group 2 only 3 patients developed the infections. Hence no significance in lowering incidence of URI or vaginal infection from this study. 8) Culture and sensitivity showed growth of E.coli in 1.4% and staphylococcus in 1% of the prophylactic group. In group 2, 7.6% were positive for E.coli, 1.2% for Klebsiella and 5.8% for staphylococci. The ‘p’ value was less than 0.01 and it is statistically significant. 9) Ciprofloxacin, norfloxacin and chloroquine were the additional drugs used in group 1. In addition group 2 patients used Ceftriaxone and ampicillin. 10) There was not much difference in overall mean hospital stay among the two groups. 11) Single dose antibiotic prophylaxis with Cefotaxime was found to be cost effective compared to conventional post-operative antibiotics. CONCLUSION: From the present study, single dose antibiotic prophylaxis with Inj.Cefotaxime 2 gms i.v given at the time of cord clamping is safe, cost effective and also effective in reducing the post-operative morbidity in terms of fever, urinary tract infection, wound sepsis, vaginal and uterine infection. It is absolutely beneficial to the community as it prevents infections, prevents unnecessary usage of additional antibiotics, and decreases cost of treatment, development of resistance and post-operative morbidity.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Comparison ; prophylactic ; Regular use ; antibiotic ; caesarean section. |
| Subjects: | MEDICAL > Obstetrics and Gynaecology |
| Depositing User: | Subramani R |
| Date Deposited: | 25 Nov 2017 07:14 |
| Last Modified: | 28 Nov 2017 02:11 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/4051 |
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