CoChat
Sign Up
Cited by 575Surgical site infection preventionMaternal and Perinatal Health InterventionsNeonatal and Maternal Infections

The DOI matches its Crossref record; 200 of the 206 references it cites were found in a registry or an index.

Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section

Open access
Smaill, Fiona M, Grivell, Rosalie M·2014·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd007482.pub3PMC PMC8078551
Open this paper in CoChat — free account

Abstract

BACKGROUND: The single most important risk factor for postpartum maternal infection is cesarean section. Although guidelines endorse the use of prophylactic antibiotics for women undergoing cesarean section, there is not uniform implementation of this recommendation. This is an update of a Cochrane review first published in 1995 and last updated in 2010. OBJECTIVES: To assess the effects of prophylactic antibiotics compared with no prophylactic antibiotics on infectious complications in women undergoing cesarean section. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2014) and reference lists of retrieved papers. SELECTION CRITERIA: Randomized controlled trials (RCTs) and quasi-RCTs comparing the effects of prophylactic antibiotics versus no treatment in women undergoing cesarean section. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. The clinically important primary outcomes were wound infection, endometritis, serious maternal infectious complications and adverse effects on the infant. We presented dichotomous data as risk ratios (RR), with 95% confidence intervals (CIs) and combined trials in meta-analyses. We assessed the quality of evidence using the GRADE approach. MAIN RESULTS: We identified 95 studies enrolling over 15,000 women. Compared with placebo or no treatment, the use of prophylactic antibiotics in women undergoing cesarean section reduced the incidence of wound infection (RR 0.40, 95% CI 0.35 to 0.46, 82 studies, 14,407 women), endometritis (RR 0.38, 95% CI 0.34 to 0.42, 83 studies, 13,548 women) and maternal serious infectious complications (RR 0.31, 95% CI 0.20 to 0.49, 32 studies, 6159 women). When only studies that included women undergoing an elective cesarean section were analyzed, there was also a reduction in the incidence of wound infections (RR 0.62, 95% CI 0.47 to 0.82, 17 studies, 3537 women) and endometritis (RR 0.38, 95% CI 0.24 to 0.61, 15 studies, 2502 women) with prophylactic antibiotics. Similar estimates of effect were seen whether the antibiotics were administered before the cord was clamped or after. The effect of different antibiotic regimens was studied and similar reductions in the incidence of infections were seen for most of the antibiotics and combinations.There were no data on which to estimate the effect of maternal administration of antibiotics on infant outcomes. No studies systematically collected and reported on adverse infant outcomes nor the effect of antibiotics on the developing infant immune system. No studies reported on the incidence of oral candidiasis (thrush) in babies. Maternal adverse effects were also rarely described.We judged the evidence for antibiotic treatment compared with no treatment to be of moderate quality; most studies lacked an adequate description of methods and were assessed as being at unclear risk of bias. AUTHORS' CONCLUSIONS: The conclusions of this review support the recommendation that prophylactic antibiotics should be routinely administered to all women undergoing cesarean section to prevent infection. Compared with placebo or no treatment, the use of prophylactic antibiotics in women undergoing cesarean section reduced the incidence of wound infection, endometritis and serious infectious complications by 60% to 70%. There were few data on adverse effects and no information on the effect of antibiotics on the baby, making the assessment of overall benefits and harms difficult. Prophylactic antibiotics given to all women undergoing elective or non-elective cesarean section is beneficial for women but there is uncertainty about the consequences for the baby.

Overview

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1002/14651858.cd007482.pub3

Cites

200 of 200 references verified0 citation errors · 0 not checkable

Statistics

Verification

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Citations

Cites

2 retracted

Flagged first, then by citations

Show all 206 references

6 of the 206 references couldn’t be matched to a known paper.

Research works printed but not linked: 36

  1. Bagratee JS Moodley J Antibiotic prophylaxis in elective caesarean section Women's Health - into the new millenium. Proceedings of the 4th International Scientific Meeting of the Royal College of Obstetricians and Gynaecologists; 1999 Oct 3-6; Cape Town South Africa 1999 6
  2. Bibi, 1994, Antibiotic prophylaxis in a priori cesarean sections without a high risk of infection, Journal de Gynecologie, Obstetrique et Biologie de la Reproduction (Paris), 23, 451
  3. Carl, 2000, Normal saline pelvic and intrauterine irrigation in the high-risk cesarean section (CS) patient as a safe and cost-effective method of infection prophylaxis, American Journal of Obstetrics and Gynecology, 182, S96
  4. Conover, 1984, Comparison of irrigation and intravenous antibiotic prophylaxis at cesarean section, Obstetrics and Gynecology, 63, 787
  5. Cormier, 1991, Antibiotic prophylaxis after caesarean section, Journal de Gynecologie, Obstetrique et Biologie de la Reproduction, 20, 600
  6. Fugere, 1983, Use of cephalosporins in antibiotic prophylaxis in women undergoing nonelective caesarean section, Canadian Medical Association Journal, 129, 132
  7. Garcia, 1992, Incidence of urinary infection and other infectious complications in antibiotic prophylaxis of cesaran section with ultra-short schedule. III, Tokoginecologia Practica, 51, 349
  8. Gerstner, 1980, Perioperative metronidazol-prophylaxis for cesarean section, Zeitschrift fur Geburtshilfe und Perinatologie, 184, 418
  9. Lappas, 1985, Double-blind comparative study of metronidazole iv vs placebo in the prophylaxis of sepsis following cesarean section, Archives of Gynecology, 237, 279
  10. Leonetti, 1989, Single vs multiple dose piperacillin in high risk primary cesarean section, American Journal of Gynecologic Health, 3, 195
  11. Magro, 1983, A controlled clinical study of cefuroxim for antimicrobial prophylaxis during obstetric and gynecological surgery, Clinica Terapeutica, 105, 209
  12. Miller, 1968, Ampicillin prophylaxis in caesarean section, South African Journal of Obstetrics and Gynaecology, 6, 69
  13. Oestreicher, 1987, Prospective study on the question of single-dose antibiotic prophylaxis for primarily indicated abdominal cesarean section (translation), Zeitschrift fur Geburtshilfe und Perinatologie, 191, 12
  14. Racinet, 1990, Antibiotic prophylaxis in cesarean sections without high risk of infection, Presse Medicale, 19, 1755
  15. Reckel, 1985, Perioperative antibiotic prophylaxis in cesarean section, Der Klinikarzt, 14, 1054
  16. Roex, 1987, Short-term antibiotic prophylaxis for caesarean section, Nederland Tijdschrift voor Obstetrie en Gynaecologie, 100, 105
  17. Sokolowski, 1989, Influence of vagimid prophylaxis on course of puerperium and healing of the wound after caesarean section in comparison with a control group, Zentralblatt fur Gynakologie, 111, 461
  18. Sziller, 1994, Postoperative infectious morbidity after perioperative ampicillin /sulbactam prophylaxis in women undergoing elective caesarean section, Magyar Norvosok Lapja, 57, 101
  19. Ujah I Olarewaju R The use of prophyactic Augmentin in elective caesarean section in Jos University teaching hospital Proceedings of 26th British Congress of Obstetrics and Gynaecology; 1992 July 7-10; Manchester, UK 1992 484
  20. Walss Rodriguez, 1990, Prophylactic antimicrobial therapy in cesarean section, Ginecologia y Obstetricia de Mexico, 58, 79
  21. Wu, 1991, Prevention of post-operative infection by uterine and intraperitoneal irrigation with ampicillin during cesarean section, International Journal of Experimental and Clinical Chemotherapy, 4, 132
  22. Cormier, 1988, Antibiotic prophylaxis with cefotetan in the prevention of post-partum and post-abortum infectious complications in endo-uterine investigations, Revue Francaise de Gynecologie et d Obstetrique, 83, 829
  23. Harrigill, 2000, The effect of intra-abdominal irrigation at cesarean section on maternal morbidity, American Journal of Obstetrics and Gynecology, 182, S161
  24. Pawelec M Michalik T Robaczynski J One-dose administration of Mandol in the prevention of infection after caesarean section Proceedings of 14th European Congress of Perinatal Medicine; 1994 June 5-8; Helsinki, Finland 1994 389
  25. Sanchez-Ramos, 1999, Preoperative administration of intravaginal metronidazole for the prevention of post-cesarean endometritis: a randomized double-blind trial, American Journal of Obstetrics and Gynecology, 180 (1 Pt 2), S:81
  26. Voto, 1986, Prophylaxis of post cesarean section puerperal infection with the using of cefoxitin antibiotics, Obstetricia y Ginecologia Latino-Americanas, 44, 419
  27. Wells, 1994, Antibiotic prophylaxis in emergency caesarean section, International Journal of Gynecology & Obstetrics, 46, 77
  28. Desjardins, 1996, Retrospective study of post-cesarean endometritis. 1992-1993, Journal de Gynecologie, Obstetrique et Biologie de la Reproduction, 25, 419
  29. Enkin, 1989, Prophylactic antibiotics in association with caesarean section, 1246
  30. MacLean, 1990, Puerperal pyrexia, 195
  31. National Institute for Health and Clinical Excellence, 2011, Caesarean Section. NICE Clinical Guideline 132
  32. The Cochrane Collaboration Review Manager (RevMan) 2014
  33. Schunemann, 2009, GRADE: from grading the evidence to developing recommendations. A description of the system and a proposal regarding the transferability of the results of clinical research to clinical practice, Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen, 103, 391
  34. Talbot, 2005, Postoperative infections and antimicrobial prophylaxis, 3533
  35. Wax, 1997, Single dose cefazolin prophylaxis for postcesarean infections: before vs after cord clamping, Journal of Maternal Fetal Medicine, 6, 61
  36. Smaill F Prophylactic antibiotics for elective Caesarean section [revised 06 May 1993] In: Enkin MW, Keirse MJNC, Renfrew MJ, Neilson JP, Crowther C (eds.) Pregnancy and Childbirth Module. In: The Cochrane Pregnancy and Childbirth Database [database on disk and CDROM]. The Cochrane Collaboration; Issue 2, Oxford: Update Software; 1995

Cited by

Sorted by citations

Related

See all

Metadata

Authors
Smaill, F. M., & Grivell, R. M.
Affiliations
  • McMaster University (CA)
  • Women's and Children's Hospital (AU)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2014-10-28
Volume
2014
Issue
10
Pages
CD007482-CD007482
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd007482.pub3
PMC
PMC8078551
OpenAlex
W1771339314
Cited by
575
References
206
Citations by year
2026: 13 · 2025: 28 · 2024: 34 · 2023: 34 · 2022: 58 · 2021: 52 · 2020: 54 · 2019: 48 · 2018: 42 · 2017: 49 · 2016: 30 · 2015: 22 · 2014: 29
FWCI
8.18
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Surgical site infection prevention
  • Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Neonatal and Maternal Infections
Keywords
antibiotic prophylaxis, cesarean section, surgical site infection, endometritis, elective cesarean section, antibiotic adverse effects, neonatal infection
MeSH terms
Bacterial Infections, Cesarean Section, Endometritis, Female, Humans, Postoperative Complications, Pregnancy, Surgical Wound Infection, Urinary Tract Infections, Randomized Controlled Trials as Topic, Antibiotic Prophylaxis

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review