The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China.
Arch Gynecol Obstet. 2021 Feb;303(2):313-320. doi: 10.1007/s00404-020-05873-z. Epub 2020 Nov 26.
To summarize the available evidence to explore the effect of different prophylactic cefazolin regimens on postoperative surgical site infection after cesarean section.
We searched WOS, Pubmed, and EMBASE Database also traced citations in the reference sections of the retrieved studies. English search words: Cesarean section, Surgical site infection, Cefazolin. The majority of the literature are randomized controlled trials comparing varied regimens of cefazolin.
A total of 11 randomized controlled trials and 4 non-randomized controlled trials involving 16,328 pregnant women were eligible. There was no statistically significant difference in the risk of SSI after cesarean section when cefazolin was given at a high dose compared with cefazolin at a low dose (OR 0.77, 95% CI 0.57-1.04, I = 0.0%). The risk of SSI after cesarean section was reduced by prophylactic use of cefazolin before skin incision compared with that after the umbilical cord clamping (OR 0.48, 95% CI 0.29-0.82, I = 53.4%). Because of the extreme heterogeneity of the combined drug use, no meta-analysis results were provided. The consequences of cefazolin combined with other antibiotics (either orally or intravenously) vary widely. For pregnant women with different risk factors, cefazolin alone or the type, dose and drug route of cefazolin combined with additional antibiotics need to be further studied and explored.
All in all, this article illustrates a better use of cefazolin for the control of Surgical incision site infection in the cesarean section. For pregnant women with cesarean section without high-risk factors of infection, the use of cefazolin is effective, but for pregnant women with different high-risk factors, the specific use of prophylactic antibiotics needs to be further explored.
总结现有证据，探讨剖宫产术后不同头孢唑林预防方案对手术部位感染的影响。
我们检索了 WOS、Pubmed 和 EMBASE 数据库，并追溯了检索研究参考文献中的引文。英文检索词：剖宫产术、手术部位感染、头孢唑林。大多数文献是比较不同头孢唑林方案的随机对照试验。
共有 11 项随机对照试验和 4 项非随机对照试验纳入了 16328 名孕妇。与低剂量头孢唑林相比，高剂量头孢唑林用于剖宫产时，手术部位感染的风险无统计学差异（OR 0.77，95%CI 0.57-1.04，I=0.0%）。与脐带夹闭后使用相比，在皮肤切开前预防性使用头孢唑林可降低剖宫产术后手术部位感染的风险（OR 0.48，95%CI 0.29-0.82，I=53.4%）。由于联合用药的极端异质性，未提供荟萃分析结果。头孢唑林联合其他抗生素（口服或静脉）的后果差异很大。对于具有不同危险因素的孕妇，需要进一步研究和探索头孢唑林单独使用或头孢唑林与其他抗生素联合使用的类型、剂量和药物途径。
总而言之，本文说明了头孢唑林在控制剖宫产手术部位感染方面的更好应用。对于无感染高危因素的剖宫产孕妇，使用头孢唑林是有效的，但对于具有不同高危因素的孕妇，具体使用预防性抗生素需要进一步探讨。
