Department of Anaesthesiology, Klinikum Bamberg, Bamberg, Germany.
BMJ Open. 2013 Apr 18;3(4). doi: 10.1136/bmjopen-2012-002028. Print 2013.
To assess the effects on maternal infectious morbidity and neonatal outcomes of the timing of antibiotic prophylaxis in women undergoing caesarean section. A recent National Institute for Health and Clinical Excellence (NICE) guideline reported that antibiotic administration before skin incision reduces the risk of maternal infection; this recommendation was based on a meta-analysis, however one including trials that were not double blind and not including a trial published recently.
Systematic review and meta-analysis.
Searches of PubMed and EMBASE and reference lists of the retrieved articles.
Randomised double-blind controlled trials comparing the administration of antibiotics before skin incision with administration after cord clamping.
Data on maternal total infectious morbidity, endometritis and wound infection, as well as neonatal intensive care unit admission, neonatal infection and neonatal sepsis were extracted and combined using random effects meta-analysis.
Five studies reporting on 1777 parturients were included in our systematic review. The relative risk (RR) for maternal total infectious morbidity for antibiotic administration before incision compared with antibiotic administration after cord clamping was 0.64 (95% CI 0.36 to 1.15). Likewise, there was no difference in the risk of wound infection (RR 0.72, 95% CI 0.41 to 1.27). Parturients receiving the antibiotic preoperatively had a significantly reduced risk of endometritis (RR 0.48, 95% CI 0.27 to 0.87; number needed to treat 41, 95% CI 23 to 165). Analyses of the neonatal outcome parameters revealed no differences between the regimens of antibiotic administration, but were based on few studies.
In contrast to a recent NICE guideline, we did not find a reduction in total infectious morbidity with antibiotic administration before skin incision; we confirmed a reduction in the risk of endometritis and a lack of effect on the risk for wound infection.
评估剖宫产术中抗生素预防时机对产妇感染发病率和新生儿结局的影响。最近，英国国家卫生与临床优化研究所（NICE）指南报告称，在切开皮肤前使用抗生素可降低产妇感染的风险；这一建议是基于荟萃分析得出的，但其中包括了一些非双盲试验，并且没有包括最近发表的一项试验。
系统评价和荟萃分析。
PubMed 和 EMBASE 的检索以及检索到的文章的参考文献列表。
比较切开皮肤前使用抗生素与断脐后使用抗生素的随机双盲对照试验。
提取并使用随机效应荟萃分析合并了产妇总感染发病率、子宫内膜炎和伤口感染以及新生儿重症监护病房入院、新生儿感染和新生儿败血症的数据。
我们的系统评价纳入了五项研究，共 1777 名产妇。与断脐后使用抗生素相比，切开皮肤前使用抗生素的产妇总感染发病率的相对风险（RR）为 0.64（95%可信区间 0.36 至 1.15）。同样，伤口感染的风险也没有差异（RR 0.72，95%可信区间 0.41 至 1.27）。术前使用抗生素的产妇子宫内膜炎的风险显著降低（RR 0.48，95%可信区间 0.27 至 0.87；需要治疗的人数 41，95%可信区间 23 至 165）。对新生儿结局参数的分析显示，两种抗生素给药方案之间没有差异，但基于的研究较少。
与最近的 NICE 指南相反，我们没有发现切开皮肤前使用抗生素会降低总感染发病率；我们确认了降低子宫内膜炎风险的效果，并且对伤口感染风险没有影响。
