Antimicrobial Prophylaxis in Cesarean Section in Russian Hospitals

Abstract

Surgical antimicrobial prophylaxis is known to be the most effective means of preventing postoperative infectious complications. Current guidelines recommend to use cefazolin, cefuroxime or amoxicillin/clavulanate as the drugs of choice for prophylaxis in cesarean section (CS). The aim of our study was to review the practice of antimicrobial prophylaxis in CS in Russian hospitals. Multicenter retrospective pharmacoepidemiological study in 14 clinics (10 cities) was performed. The highest rate of infectious complications in cesarean section was observed in patients either with no antimicrobial prophylaxis (9.8%) or with inadequate timing of prophylaxis (3.8–4.5%). When the time of antimicrobial prophylaxis was adequate (i.e. after umbilical cord is clamped), as observed in 24.9% of patients, then the incidence of infectious complications was minimal (2.0%). However, antimicrobial prophylaxis was often administered at the time when it couldn’t affect the risk of infectious complications (65.7%). The most frequently administered antibiotics were cephalosporins (72.8%) and penicillins (11.1%). There was inappropriately frequent use of metronidazole (15.7%) and aminoglycosides (8.7%). Other antimicrobials (macrolides, lincosamides, nitrofurans, nystatin) were used more rarely. Therefore, antimicrobial prophylaxis in CS in Russian clinical practice is adequate only in 24.9% of patients. The most common errors include: inadequate timing, inappropriate choice of antimicrobials and administration of antibiotics 1-3 days after surgery.