Smaill Fiona M, Gyte Gillian Ml
Department of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Room 2N16, 1200 Main Street West, Hamilton, Ontario, Canada, L8N 3Z5.
Cochrane Database Syst Rev. 2010 Jan 20(1):CD007482. doi: 10.1002/14651858.CD007482.pub2.
The single most important risk factor for postpartum maternal infection is cesarean section. Routine prophylaxis with antibiotics may reduce this risk and should be assessed in terms of benefits and harms.
To assess the effects of prophylactic antibiotics compared with no prophylactic antibiotics on infectious complications in women undergoing cesarean section.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (May 2009).
Randomized controlled trials (RCTs) and quasi-RCTs comparing the effects of prophylactic antibiotics versus no treatment in women undergoing cesarean section.
Two authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction.
We identified 86 studies involving over 13,000 women. Prophylactic antibiotics in women undergoing cesarean section substantially reduced the incidence of febrile morbidity (average risk ratio (RR) 0.45; 95% confidence interval (CI) 0.39 to 0.51, 50 studies, 8141 women), wound infection (average RR 0.39; 95% CI 0.32 to 0.48, 77 studies, 11,961 women), endometritis (RR 0.38; 95% CI 0.34 to 0.42, 79 studies, 12,142 women) and serious maternal infectious complications (RR 0.31; 95% CI 0.19 to 0.48, 31 studies, 5047 women). No conclusions can be made about other maternal adverse effects from these studies (RR 2.43; 95% CI 1.00 to 5.90, 13 studies, 2131 women). None of the 86 studies reported infant adverse outcomes and in particular there was no assessment of infant oral thrush. There was no systematic collection of data on bacterial drug resistance. The findings were similar whether the cesarean section was elective or non elective, and whether the antibiotic was given before or after umbilical cord clamping. Overall, the methodological quality of the trials was unclear and in only a few studies was it obvious that potential other sources of bias had been adequately addressed.
AUTHORS' CONCLUSIONS: Endometritis was reduced by two thirds to three quarters and a decrease in wound infection was also identified. However, there was incomplete information collected about potential adverse effects, including the effect of antibiotics on the baby, making the assessment of overall benefits and harms complicated. Prophylactic antibiotics given to all women undergoing elective or non-elective cesarean section is clearly beneficial for women but there is uncertainty about the consequences for the baby.
剖宫产是产后产妇感染的唯一最重要风险因素。常规使用抗生素进行预防可能会降低这种风险，应从利弊两方面进行评估。
评估预防性使用抗生素与不使用抗生素相比，对剖宫产妇女感染并发症的影响。
我们检索了Cochrane妊娠与分娩组试验注册库（2009年5月）。
比较预防性使用抗生素与不进行治疗对剖宫产妇女影响的随机对照试验（RCT）和半随机对照试验。
两位作者独立评估纳入研究，评估偏倚风险并进行数据提取。
我们确定了86项涉及超过13000名妇女的研究。剖宫产妇女预防性使用抗生素可大幅降低发热性疾病的发生率（平均风险比（RR）0.45；95%置信区间（CI）0.39至0.51，50项研究，8141名妇女）、伤口感染（平均RR 0.39；95%CI 0.32至0.48，77项研究，11961名妇女）、子宫内膜炎（RR 0.38；95%CI 0.34至0.42，79项研究，12142名妇女）和严重的产妇感染并发症（RR 0.31；95%CI 0.19至0.48，31项研究，5047名妇女）。这些研究无法得出关于其他产妇不良反应的结论（RR 2.43；95%CI 1.00至5.90，13项研究，2131名妇女）。86项研究中均未报告婴儿不良结局，尤其未评估婴儿鹅口疮。未系统收集关于细菌耐药性的数据。无论剖宫产是选择性还是非选择性，以及抗生素是在脐带夹闭前还是后给予，结果相似。总体而言，试验的方法学质量不明确，只有少数研究明显充分解决了潜在的其他偏倚来源。
子宫内膜炎减少了三分之二至四分之三，伤口感染也有所减少。然而，关于潜在不良反应，包括抗生素对婴儿的影响，收集的信息不完整，使得对总体利弊的评估变得复杂。对所有接受选择性或非选择性剖宫产的妇女预防性使用抗生素对妇女明显有益，但对婴儿的影响尚不确定。
