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Different classes of antibiotics given to women routinely for preventing infection at caesarean section

  • Review
  • Intervention

Authors

  • Zarko Alfirevic,

    Corresponding author
    1. The University of Liverpool, School of Reproductive and Developmental Medicine, Division of Perinatal and Reproductive Medicine, Liverpool, UK
    • Zarko Alfirevic, School of Reproductive and Developmental Medicine, Division of Perinatal and Reproductive Medicine, The University of Liverpool, First Floor, Liverpool Women's NHS Foundation Trust, Crown Street, Liverpool, L8 7SS, UK. zarko@liverpool.ac.uk.

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  • Gillian ML Gyte,

    1. The University of Liverpool, Cochrane Pregnancy and Childbirth Group, School of Reproductive and Developmental Medicine, Division of Perinatal and Reproductive Medicine, Liverpool, UK
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  • Lixia Dou

    1. The University of Liverpool, Cochrane Pregnancy and Childbirth Group, School of Reproductive and Developmental Medicine, Division of Perinatal and Reproductive Medicine, Liverpool, UK
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Abstract

Background

Caesarean section increases the risk of postpartum infection for women and prophylactic antibiotics have been shown to reduce the incidence; however, there are adverse effects. It is important to identify the most effective class of antibiotics to use and those with the least adverse effects.

Objectives

To determine, from the best available evidence, the balance of benefits and harms between different classes of antibiotic given prophylactically to women undergoing caesarean section.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (April 2010) and reference lists of retrieved papers.

Selection criteria

We included randomised controlled trials comparing different classes of prophylactic antibiotics given to women undergoing caesarean section. We excluded trials that compared drugs with placebo or drugs within a specific class; these are assessed in other Cochrane Reviews.

Data collection and analysis

Two review authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction.

Main results

We included 29 studies of which 25 provided data on 6367 women. There was a lack of good quality data and important outcomes often included only small numbers of women. This meant we could only conclude that the current evidence shows no overall difference between the different classes of antibiotics in terms of reducing maternal infections after caesarean sections. However, none of the studies looked at outcomes on the baby, nor did they report infections diagnosed after the initial postoperative hospital stay. We were unable to assess what impact, if any, the use of different classes of antibiotics might have on bacterial resistance.

Authors' conclusions

Based on the best currently available evidence, cephalosporins and penicillins have similar efficacy at caesarean section when considering immediate postoperative infections. We have no data for outcomes on the baby, nor on late infections (up to 30 days) in the mother. Clinicians need to consider bacterial resistance and women's individual circumstances.

Resumen

Antecedentes

Administración sistemática de diferentes clases de antibióticos a las mujeres para la prevención de la infección en la cesárea

La cesárea aumenta el riesgo de infección posparto para las mujeres y se ha demostrado que los antibióticos profilácticos reducen su incidencia; sin embargo, hay efectos adversos. Es importante identificar la clase de antibióticos más efectiva a utilizar y los que ocasionan menos efectos adversos.

Objetivos

Determinar, a partir de las mejores pruebas disponibles, el equilibrio entre los beneficios y los daños de diferentes clases de antibióticos administrados como profilaxis a las mujeres a las que se les realiza una cesárea.

Estrategia de búsqueda

Se hicieron búsquedas en el registro de ensayos del Grupo Cochrane de Embarazo y Parto (Cochrane Pregnancy and Childbirth Group) (abril 2010) y en las listas de referencias de los artículos recuperados.

Criterios de selección

Se incluyeron ensayos controlados aleatorios que compararon diferentes clases de antibióticos profilácticos administrados a las mujeres a las que se les realizó una cesárea. Se excluyeron los ensayos que compararon fármacos con placebo o fármacos dentro de una clase específica; los mismos se evalúan en otras revisiones Cochrane.

Obtención y análisis de los datos

Dos revisores evaluaron de forma independiente los estudios para la inclusión, evaluaron el riesgo de sesgo y realizaron la extracción de datos.

Resultados principales

Se incluyeron 29 estudios, de los cuales 25 proporcionaron datos sobre 6367 mujeres. Hubo falta de datos de buena calidad y los resultados importantes a menudo sólo incluyeron escasos números de mujeres. Lo anterior significó que sólo fue posible concluir que las pruebas actuales no muestran diferencias generales entre las diferentes clases de antibióticos en cuanto a la reducción de las infecciones maternas después de la cesárea. Sin embargo, ninguno de los estudios consideró los resultados del recién nacido ni informó infecciones diagnosticadas después de la estancia hospitalaria postoperatoria inicial. No fue posible evaluar qué repercusión, si hubo alguna, podría tener el uso de diferentes clases de antibióticos sobre la resistencia bacteriana.

Conclusiones de los autores

Según las mejores pruebas actualmente disponibles, las cefalosporinas y las penicilinas tienen una eficacia similar en la cesárea cuando se analizan las infecciones postoperatorias inmediatas. No existen datos para los resultados del recién nacido ni para las infecciones tardías (hasta 30 días) en la madre. Los médicos deben considerar la resistencia bacteriana y las circunstancias individuales de las mujeres.

Traducción

Traducción realizada por el Centro Cochrane Iberoamericano

摘要

背景

不同種類抗生素的例行性使用以預防剖腹產產婦感染

有證據顯示預防性抗生素可降低剖腹產產婦產後感染的風險與發生率; 也會有副作用,找出最有效的和副作用最少的抗生素種類是很重要的

目標

以最大的有效證據來評估不同種類預防性抗生素對剖腹產產婦的好處及傷害.

搜尋策略

搜尋Cochrane Pregnancy 與 Childbirth Group's Trials Register (2010年4月) 和找資料庫中參考文獻所列出的論文.

選擇標準

納入比較不同種類預防性抗生素用於剖腹產產婦的隨機對照試驗.排除與安慰劑或只有同類不同藥物的比較的試驗; 後者納入別的回顧文章中

資料收集與分析

以兩個回顧作者獨立評估研究,可評估偏差風險並執行資料選取

主要結論

納入29個試驗,其中25個包含 6367 位產婦.試驗結果缺少品質良好的數據,重要的結果都是來自樣本少的試驗.只能總結:目前證據顯示不同種類的抗生素對產婦剖腹產後感染率沒有整體差異.但沒有研究觀察胎兒狀況,或出院後的感染診斷.也無法評估使用不同種類抗生素在細菌抗藥性的影響.

作者結論

根據現有最好的證據顯示:cephalosporins和penicillins 對剖腹產手術後當下感染的效果相當.沒有研究觀察胎兒狀況,或產婦晚期感染 (30天內) 的資料.醫生需考慮細菌抗藥性和產婦個人狀態

翻譯人

本摘要由成功大學附設醫院尹子真翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

比較不同種類抗生素的例行性使用以預防剖腹產產婦感染:剖腹產產婦比自然產產婦有較高的產後感染風險.感染可能出現於手術傷口或尿液中,也會感染骨盆內器官如子宮內膜 (子宮內膜炎). 感染可能變的很嚴重,例如骨盆內感染引起菌血症偶爾會導致產婦死亡.為了預防手術感染,一般認為宣導手術技術是很重要,再輔以皮膚消毒和抗生素使用.但抗生素有副作用如母親噁心,嘔吐,皮膚疹和罕見的過敏反應,也會對母親及嬰兒產生鵝口瘡 (念珠菌) 風險.於生產時給產婦使用抗生素會改變胎兒幫助免疫系統發展的腸道菌群.因此此時用抗生素會干擾孩童免疫系統發展.本回顧研究哪種抗生素效果最好.我們找到25個隨機試驗,包含 6367 位產婦.試驗比較cephalosporins和penicillins.這兩者cephalosporins和penicillins對剖腹產術後降低感染的效果和副作用相當.但納入的研究都沒有觀察產婦出院回家後的感染資料.不論是選擇性或緊急剖腹產產婦,其藥效相似.沒有研究觀察胎兒狀況,不知這方面是否有某類抗生素療效較佳.需考慮給哺乳時可用的抗生素. Tetracyclines 會引起嬰兒牙齒變色,應避免使用.我們無法評估使用不同種類抗生素對細菌抗藥性可能有的影響,如果有影響的話.這是使用抗生素的重要關鍵因子.

Plain language summary

Comparing different types of antibiotics given routinely to women at caesarean section to prevent infections

Women undergoing caesarean section have an increased likelihood of getting an infection compared with women who give birth vaginally. These infections can be in the surgical incision or in the urine. The infection can also be in the organs within the pelvis, such as the lining of the womb (endometritis). The infections can become serious, causing, for example, an abscess in the pelvis or infection in the blood, and very occasionally can lead to the mother's death. For the prevention of surgical infections, it is generally considered that sound surgical technique is important along with skin antiseptics and the use of antibiotics. However, antibiotics can cause adverse effects such as nausea, vomiting, skin rash and rarely allergic reactions in the mother, and the risk of thrush (candida) for the mother and the baby. Antibiotics, given to women around the time of giving birth, can also change the baby's gut flora which contribute to the baby's developing immune system. Thus antibiotics given at this time may interfere with the baby's developing immune system. This review looked at which types of antibiotics might work best. We found 25 randomised studies, involving 6367 women, which compared cephalosporins with penicillins. Cephalosporins and penicillins had similar effects in reducing infections after caesareans and similar adverse effects. However, none of the included studies assessed infections that arise after the woman is discharged home. The effects were similar whether the caesarean section was an elective or emergency caesarean. None of the studies looked at outcomes on the babies, so it is unclear if one class of antibiotic might be better than another in this respect. Consideration also needs to be given to antibiotics compatible with breastfeeding. Tetracyclines can cause discolouration of teeth in children and are best avoided. We were unable to assess what impact, if any, the use of different types of antibiotics might have on bacterial resistance, and this is a crucial issue when considering which antibiotic might be used.

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