Ben Shoham Assaf, Bar-Meir Maskit, Ioscovich Alexander, Samueloff Arnon, Wiener-Well Yonit
a Department of Internal Medicine , Shaare Zedek Medical Center , Jerusalem , Israel.
b Department of Pediatric Infectious Diseases, Shaare Zedek Medical Center, Faculty of Medicine , Hebrew University of Jerusalem Hadassah Medical School , Jerusalem , Israel.
J Matern Fetal Neonatal Med. 2019 Mar;32(5):804-808. doi: 10.1080/14767058.2017.1391784. Epub 2017 Oct 26.
Cesarean section (CS) is one of the most common surgical procedures performed worldwide. Surgical-site-infection (SSI) occurs in approximately 5-10% of CS. The benefit of prophylactic antibiotics for prevention of SSI has been demonstrated in the literature. The optimal timing of antibiotic prophylaxis (prior to surgical incision versus after cord clamping) was investigated in recent studies. In January 2014, the Israeli Ministry of Health introduced a national quality measure which monitors the administration of prophylactic antibiotics in CS. The custom clinical practice in our medical center was to administer prophylactic antibiotics immediately after cord clamping. Upon introduction of the national quality measurement program, the practice was changed to administration of antibiotics prior to surgical incision. Our objective was to examine the effect of timing of prophylactic antibiotics administration on the incidence of SSI following CS, in a single medical center that performs a large volume of deliveries, with a low rate of CS.
Taking advantage of a discrete change in clinical practice, we used retrospective data and applied difference-in-differences design to estimate the effect of the timing of prophylactic antibiotics administration on SSI rates. The analysis included all CSs performed during 2012-2015 and all hysterectomies conducted during the study period.
The coverage rates of prophylactic antibiotics in CS before and after the policy change were 99.10% and 99.03%, respectively. The rates of SSI following CS, before and after the policy change, were 2.63% (n = 2499) and 2.32% (n = 3840), respectively. The rates of SSI following hysterectomy, before and after the policy, change were 6.82% (n = 396) and 7.09% (n = 437), respectively. Difference-in-differences (DID) estimates of the effect of policy change on the incidence of SSI in linear and logistic regression models were not significant (B = -0.6%, p = .64; odds ratio = 0.84, p = .58, respectively).
We found no effect of the timing of prophylactic antibiotic administration (prior to surgical incision versus after cord clamping) on SSI rates following CS.
剖宫产术是全球最常见的外科手术之一。外科手术部位感染（SSI）发生率约为5% - 10%。文献已证实预防性使用抗生素对预防SSI有益。近期研究探讨了预防性使用抗生素的最佳时机（手术切口前与脐带结扎后）。2014年1月，以色列卫生部出台一项全国性质量指标，监测剖宫产术中预防性抗生素的使用情况。我们医疗中心的常规临床做法是在脐带结扎后立即使用预防性抗生素。在引入全国性质量监测项目后，做法改为在手术切口前使用抗生素。我们的目的是在一家分娩量大、剖宫产率低的单一医疗中心，研究预防性抗生素使用时机对剖宫产术后SSI发生率的影响。
利用临床实践中的离散变化，我们采用回顾性数据并应用差异中的差异设计来估计预防性抗生素使用时机对SSI发生率的影响。分析包括2012 - 2015年期间进行的所有剖宫产术以及研究期间进行的所有子宫切除术。
政策改变前后剖宫产术中预防性抗生素的覆盖率分别为99.10%和99.03%。政策改变前后剖宫产术后SSI发生率分别为2.63%（n = 2499）和2.32%（n = 3840）。政策改变前后子宫切除术后SSI发生率分别为6.82%（n = 396）和7.09%（n = 437）。线性和逻辑回归模型中政策改变对SSI发生率影响的差异中的差异（DID）估计均无统计学意义（B = -0.6%，p = 0.64；优势比 = 0.84，p = 0.58）。
我们发现预防性抗生素使用时机（手术切口前与脐带结扎后）对剖宫产术后SSI发生率没有影响。
