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低收入国家急诊剖宫产术中感染预防抗生素的选择:莫桑比克的一项成本效益研究

Choice of antibiotics for infection prophylaxis in emergency cesarean sections in low-income countries: a cost-benefit study in Mozambique.

作者信息

Kayihura Vicente, Osman Nafissa Bique, Bugalho Antonio, Bergström Staffan

机构信息

Department of Obstetrics and Gynecology, Maputo Central Hospital, Maputo, Mozambique.

出版信息

Acta Obstet Gynecol Scand. 2003 Jul;82(7):636-41. doi: 10.1034/j.1600-0412.2003.00205.x.

Abstract

BACKGROUND

There is a need to assess the cost-benefit of different models of antibiotic administration for the prevention of post cesarean infection, particularly in resource-scarce settings.

DESIGN

Randomized, nonblinded comparative study of a single combined preoperative dose of gentamicin and metronidazole vs. a post cesarean scheme for infection prophylaxis.

METHODS

Pregnant women (n = 288) with indication for emergency cesarean section were randomly allotted to two groups. Group 1 (n = 143) received the single, combined dose of prophylactic antibiotics and group 2 (n = 145) received, over 7 days, the postoperative standard scheme of antibiotics followed in the department. Both groups were followed up during 7 days for detection of signs of wound infection, endometritis, peritonitis and urinary tract infection.

MAIN OUTCOME MEASURES

Prevalence of postoperative infection, mean hospital stay and costs of antibiotics used.

RESULTS

Women completing the study (n = 241) were distributed into group 1 (n = 116) and group 2 (n = 125). No significant difference was found neither in the prevalence of postoperative infection nor in the mean hospital stay. No death occurred. The cost of the single dose of prophylactic antibiotics was less than one-tenth of the cost of the standard postoperative scheme.

CONCLUSION

In our setting, the administration of a single dose of 160 mg of gentamicin in combination with 500 mg of metronidazole before emergency cesarean section for prevention of infection is clinically equivalent to existing conventional week-long postoperative therapy, but at approximately one-tenth of the cost.

摘要

背景

有必要评估不同抗生素给药模式预防剖宫产术后感染的成本效益,尤其是在资源匮乏地区。

设计

对术前单次联合使用庆大霉素和甲硝唑与剖宫产术后感染预防方案进行随机、非盲对照研究。

方法

有急诊剖宫产指征的孕妇(n = 288)被随机分为两组。第1组(n = 143)接受单次联合预防性抗生素给药,第2组(n = 145)在7天内接受科室常规的术后抗生素标准方案。两组均随访7天,以检测伤口感染、子宫内膜炎、腹膜炎和尿路感染的迹象。

主要观察指标

术后感染发生率、平均住院时间和所用抗生素的费用。

结果

完成研究的女性(n = 241)被分为第1组(n = 116)和第2组(n = 125)。术后感染发生率和平均住院时间均无显著差异。无死亡病例发生。单次预防性抗生素剂量的费用不到标准术后方案费用的十分之一。

结论

在我们的研究环境中,急诊剖宫产术前单次给予160mg庆大霉素联合500mg甲硝唑预防感染在临床上等同于现有的术后为期一周的常规治疗,但成本约为其十分之一。

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