Pre & post-operative antibiotic prophylaxis: cesarean section wound complication and factors affecting duration of hospital stay

Abstract

Background: Antibiotic prophylaxis has been reported to reduce the rate of caesarian section surgical site infection and other complications. Despite such advancement, duration of time spent in hospitals after delivery varies and is reported to be longer among the caesarian delivery mothers. Therefore, understanding the factors which influence the variation of time spent in hospitals after caesarian section is important in order to optimize antibiotic prophylaxis and other interventions. Objective: Assessment of factors affecting length of hospital stay and wound complications after caesarian section among women who had received pre- or post-operative antibiotic prophylaxis at Muhimbili National Hospital Methodology: This was a prospective observational study conducted from March to April, 2016 in the Department of Obstetrics and Gynecology at Muhimbili National Hospital. It involved 242 caesarian section delivered mothers who had received prophylactic antibiotics. Maternal age, body mass index (BMI), type of caesarian section or incision, number and type of antibiotics used for prophylaxis, pre or post-operative time antibiotic had been administered were the variables extracted from patient files, nurse intervention charts as well as anaesthetic charts. Pre and post-caesarian hemoglobin (Hb) concentrations were extracted from complete blood count ordered by the obstetrician. All collected data were filled in the case report form and analyzed using Statistical Package for Social Sciences (SPSS) version 20. Results: All 242 caesarian delivered mothers received multiple doses of prophylactic antibiotics. Mode for pre-caesarian prophylactic antibiotics administration time was 60 minutes. The second doses were administered post-caesarian and had mode administration time of 120 minutes. Two hundred seventeen (89.67%) out of 242 participants were co-administered Ceftriaxone and intravenous Metronidazole. Median duration on Ceftriaxone and intravenous Metronidazole was 72 and 24 hours respectively. Hundred and nine (45%) women were prescribed an extension of five days course of oral antibiotics. Mean length of hospital stay was 4.19 ± 0.17 days. Eleven (4.55%) wound complications as dehiscence ± fever were recorded. Mean length of hospital stay was not influenced by BMI (p = 0.71), type of caesarian section (p = 0.26) and a type of incision (p = 0.17), pre-caesarian prophylactic antibiotics administration time (p = 0.55), duration on post-caesarian Ceftriaxone (p = 0.42) and on intravenous Metronidazole (p = 0.30) as well as the type of post-caesarian oral antibiotics (p = 0.77). Type of antibiotics (p = 0.001), first dose post-caesarian prophylactic antibiotic administration time (p = 0.01) and post-caesarian Hb levels (p = 0.04) had statistical significance on mean length of hospital stay. Caesarian wound complications were not influenced by BMI (p = 0.678), type of caesarian (p = 0.514) or incision (p = 0.511), pre- (p = 0.10) and post- (p = 0.61) caesarian antibiotics administration time. Type of pre-operative antibiotic prophylaxis (p = 0.0001) and post-caesarian Hb levels (p = 0.013) had statistical significant effects on wound complications. Conclusion: Mean length of hospital stay and caesarian wound complications were significantly influenced by type of prophylactic antibiotics used as well as post-caesarian Hb concentration. Pre-caesarian section antibiotic prophylaxis administration time had no influence on mean length of hospital stays. Administration of the second dose (first dose post-caesarian) within 120 minutes after caesarian section influenced the mean length of hospital stays. The combinations of one to two doses of 1g strength Ceftriaxone injection and one dose of 500mg intravenous Metronidazole resulted into shortened mean length of hospital stay, and significant reduction of caesarian wounds complications than either of the drug alone. A combination of Ceftriaxone injection with intravenous Metronidazole should be used as prophylactic antibiotics of choice in areas with limited diagnostic and patients monitoring facilities.