Analysis of the antibacterial drugs use and evaluation of the caesarean section outcomes in the ­regional perinatal center in two time periods with a 10-year interval

Cover Page


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Background. Infectious inflammatory complications that occur in women after caesarean section may affect the length of hospital stay. Timely drug therapy plays a major role in preventing the development of complications in the postoperative period.

Aim. To conduct a comparative pharmacoepidemiological analysis of antibiotics use and evaluate the surgery outcomes (on the part of the puerperal and the newborn) in women delivered by caesarean section.

Material and methods. A retrospective analysis of 1025 birth histories of women after planned and emergency caesarean section with a detailed assessment of the antibiotics use in two time periods with a 10-year interval: in 2007–2009 (first period, n=523) and in 2016–2017 (second period, n=502) was carried out. The operation outcomes, the length of hospital stay, the duration of antibiotics use were studied. The significance of differences in relative indicators was assessed by Pearson (χ2).

Results. The frequency of prescribing antibiotics in monotherapy for planned and emergency cesarean section in both time periods did not differ (p=0.858; p=0.726). There were more cases of using two antibiotics at the same time in the first period, both for planned (88 cases, 35.5%) and for emergency surgery (93 cases, 34%; p=0.001). Combinations of three antibiotics were used more frequently in the first period than in the second. The increase in body temperature after surgery (>37.5 °C) was statistically indistinguishable in two periods. The duration of hospital stay with primary antibiotic therapy in the first period was 6 bed-days, with primary antibiotic prophylaxis in the second period — 4 bed-days. Exacerbation of urinary tract infections during emergency and planned caesarean section was diagnosed 4 and 5 times more often in the first period than in the second. Outcome on the part of the newborn — an Apgar score of less than 7 points was more common with emergency intervention in the second period (10%) than in the first (3.5%; p=0.003).

Conclusion. In the first studied time period (2007–2009), with combined antibiotic therapy after caesarean section, a longer stay of women in the hospital, a higher frequency of urinary tract exacerbations in puerperas, and a better assessment of the condition of newborns according to the Apgar score were registered, compared with these indicators in the second time period (in 2016–2017), when antibiotic prophylaxis was predominantly used.

Full Text

Restricted Access

About the authors

Cholpon Cholpon Tashtanbekova

Kazan (Volga Region) Federal University

Author for correspondence.
Email: cholpon.bolotbekovna@mail.ru
ORCID iD: 0000-0003-0749-9863

assistant, Depart. of Biochemistry, Biotechnology and Pharmacology

Russian Federation, Kazan, Russia

Aleksey A. Evstratov

Republican Clinical Hospital

Email: virineia2005@mail.ru
ORCID iD: 0000-0002-9555-2611

M.D., Head, Depart. of Resuscitation and Intensive Care, Perinatal Center

Russian Federation, Kazan, Russia

El'vira G. Aleksandrova

Kazan (Volga Region) Federal University

Email: elvira_alex_75@mail.ru
ORCID iD: 0000-0002-8206-9866

M.D., Cand. Sci. (Med.), Assoc. Prof., Depart. of Biochemistry, Biotechnology and Pharmacology

Russian Federation, Kazan, Russia

Elena A. Chuenkova

Republican Clinical Hospital

Email: e-chuenkova@yandex.ru
ORCID iD: 0000-0001-9029-656X

M.D., Cand. Sci. (Med.), anesthesiologist-resuscitator of the department of anesthesiology and resuscitation

Russian Federation, Kazan, Russia

Liliya E. Ziganshina

Russian Medical Academy for Continuing Professional Education; Kazan State Medical University; Peoples' Friendship University of Russia

Email: lezign@mail.ru
ORCID iD: 0000-0003-1999-0705

M.D., D. Sci. (Med.), Prof.

Russian Federation, Moscow, Russia; Moscow, Russia; Kazan, Russia

References

  1. Pastarnak AYu. Present tendencies in the scope of delivery of women with surgically operated uterus. Sovremennye problemy nauki i obrazovaniya. 2014;(2):284. (In Russ.)
  2. Savelyeva GM. Cesarean section and its role in modern obstetrics. Akusherstvo i ginekologiya. 2008;(3):10–15. (In Russ.)
  3. Gedefaw G, Demis A, Alemnew B, Wondmieneh A, Getie A, Waltengus F. Prevalence, indications, and outcomes of caesarean section deliveries in Ethiopia: A systematic review and meta-analysis. Patient Saf Surg. 2020;14:11. doi: 10.1186/s13037-020-00236-8.
  4. Shifman YeM, Kulikov AV, Ronenson AM, Abazova IS, Adamyan LV, Andreyeva MD, Artymuk NV, Bayev OR, Barinov SV, Belokrinitskaya TYe, Blauman SI, Bratishchev IV, Bukhtin AA, Vartanov VYa, Volkov AB, Gorokhovskiy VS, Dolgushina NV, Drobinskaya AN, Kinzhalova SV, Kitiashvili IZ, Kogan IYu, Korolev AYu, Krasnopol'skiy VI, Kukarskaya II, Kurtser MA, Marshalov DV, Matkovskiy AA, Ovezov AM, Penzhoyan GA, Pestrikova TYu, Petrukhin VA, Prikhod'ko AM, Protopopova NV, Protsenko DN, Pyregov AV, Raspopin YuS, Rogachevskiy OV, Ryazanova OV, Savel'yeva GM, Semenov YuA, Sitkin SI, Fatkullin IF, Fedorova TA, Filippov OS, Shvechkova MV, Shmakov RG, Shchegolev AV, Zabolotskikh IB. Prevention, the algorithm of reference, anesthesia and intensive care for postpartum hemorrhage. Guidelines. Annals of critical care. 2019;3:9–33. (In Russ.) doi: 10.21320/1818-474X-2019-3-9-33.
  5. Fawsitt CG, Bourke J, Greene RA, Everard CM, Murphy A, Lutomski JE. At what price? A costeffectiveness analysis comparing trial of labour after previous caesarean versus elective repeat caesarean delivery. PLoS ONE. 2013;8:58577. doi: 10.1371/journal.pone.0058577.
  6. Silver RM. Delivery after previous cesarean: long-term maternal outcomes. Semin Perinatol. 2010;34(4):258–266. doi: 10.1053/j.semperi.2010.03.006.
  7. Korobkov NA, Tsoy YeR, Volkova VN. Rational antibiotic therapy of superficial infection of the surgical area after cesarean section. Infektsii v khi­rurgii. 2018;16(1–2):114–119. (In Russ.)
  8. Kan NE, Balushkina AA, Veresova AA, Zakrevskaya IV, Tyutyunnik VL. Prevention of postoperative complications in abdominal delivery. Meditsinskiy sovet. 2014;(9):96–99. (In Russ.) doi: 10.21518/2079-701X-2014-9-96-99.
  9. Aleksandrova EG, Abakumova TR, Evstigneyev SV, Titarenko AF, Khaziakhmetova VN, Ziganshina LYe. Multidisciplinary health care monito­ring and training program: impact on antibiotic use. Kazan Medical Journal. 2020;101(3):403–411. (In Russ.) doi: 10.17816/KMJ2020-403.
  10. Belousov DYu, Cheberda AYe. Pharmacoepidemiological studies: methodology and regulation. Kachestvennaya klinicheskaya praktika. 2017;(1):34–41. (In Russ.)
  11. Zyrya­nov SK. Pharmacoepidemiology yesterday, today and tomorrow. Farmateka. 2003;(3):13–17. (In Russ.)
  12. Tashtanbekova ChB, Evstratov AA, Chuenkova EA, Ziganshina LE. Perioperative antibiotic prophylaxis for abdominal delivery at the regional perinatal center. Kazan Medical Journal. 2021;102(4):428–438. (In Russ.) doi: 10.17816/KMJ2021-428.
  13. Kulikov AV, Dubrovin SG, Malkova OG. Perinatal anaesthesia risk scale and perinatal results prognosis during cesarean section. Anesteziologiya i reanimatologiya. 2012 (6):44–47. (In Russ.)
  14. Spravochnik-putevoditel' praktikuyushchego vracha. Lekarstvennyye sredstva. Pod red RV Petrova (gl red), LYe Ziganshinoy (otv red). Seriya “Dokazatel'naya meditsina”. (Handbook-guide of the practitioner. Medicines. Petrova RV, Ziganshina LE, editors. Series "Evidence Based Medicine". M.: GEOTAR-MED; 2003. 800 р. (In Russ.)
  15. Abu El Aish K, Zourob H, Madi W, El Hams S. Cefazolin alone versus cefazolin, gentamicin, and metronidazole for prophylaxis in women undergoing caesarean section: a randomised controlled trial. Lancet. 2018;391:S15. doi: 10.1016/S0140-6736(18)30340-4.
  16. Tashtanbekova ChB, Chuyenkova YeA, Yevstratov AA. Comparative analysis of the prescription of antimicrobial drugs for caesarean section in the interval of 10 years. Clinical microbio­logy and antimicrobial chemotherapy. 2018;20(S1):43. (In Russ.)
  17. Blumenfeld YJ, El-Sayed YY, Lyell DJ, Nelson LM, Butwick AJ. Risk factors for prolonged postpartum length of stay following Cesarean delivery. Am J Perinatol. 2015;32(9):825–832. doi: 10.1055/s-0034-1543953.
  18. Kawakita T, Landy HJ. Surgical site infections after cesarean delivery: Epidemiology, prevention and treatment. Matern Health, Neonatol Perinatol. 2017;3:12. doi: 10.1186/s40748-017-0051-3.
  19. Jyothi MS, Kalra JK, Arora A, Patil A, Suri V, Jain V, Shafiq N, Saini SS, Gautam V. Randomized controlled trial of cefazolin monotherapy versus cefazolin plus azithromycin single dose prophylaxis for cesarean delive­ries: A deve­loping country's perspective. J Family Med. Primary Care. 2019;8(9):3015–3021. doi: 10.4103/jfmpc.fmpc_593_19.
  20. Gruskay JA, Fu M, Basques BA, Bohl DD, Buerba RA, Webb ML, Grauer JN. Factors affecting length of stay and complications after elective anterior cervical discectomy and fusion: A study of 2164 patients from the American College of Surgeons National Surgical Qua­lity Improvement Project Database (ACS NSQIP). Clin Spine Surg. 2016;29(1):E34–E42. doi: 10.1097/BSD.0000000000000080.
  21. Rabiu KA, Akinlusi FM, Adewunmi AA, Alausa TG, Durojaiye IA. Risk factors for postcesarean wound infection in a Tertiary Hospital in Lagos, Nigeria. Niger Med J. 2020;61(5):262–268. doi: 10.4103/nmj.NMJ_1_20.
  22. Bailey SR, Field N, Townsend CL, Rodger AJ, Brocklehurst P. Antibiotic prophylaxis for women undergoing caesarean section and infant health. BJOG Int J Obstet Gyn. 2016;123:875–876. doi: 10.1111/1471-0528.13701.
  23. Mackeen AD, Packard RE, Ota E, Berghella V, Baxter JK. Timing of intravenous prophylactic antibiotics for preventing postpartum infectious morbidity in women undergoing cesarean delivery. Cochrane Database Syst Rev. 2014;(12):CD009516. doi: 10.1002/14651858.CD009516.pub2.
  24. Shmakov RG, Martirosyan SV, Mikhaylov AV, Pyregov AV, Fatkullin IF, Shifman YeM, Adamyan LV, Artymuk NV, Bayev OR, Baranov II, Bashmakova NV, Bezhenar' VF, Belokri­nitsskaya TYe, Vagushchenko UA, Dolgushina NV, Zabo­lotskikh IB, Kinzhalova SV, Klimov VA, Kozyrko YeV, Koltasheva IM, Kostin IN, Kraspol'skiy VI, Krutova VA, Kulikov AV, Logutova LS, Lyubasovskaya LA, Malyshkina AI, Oboskalova TA, Ovezov AM, Pekarev OG, Pepelyayeva NA, Perevozkina OV, Petru­khin VA, Polushkina YeS, Priputnevich TV, Prikhod'ko AM, Protsenko DN, Radzinskiy VYe, Romanov AYu, Ronenson AM, Savel'yeva GM, Semenov YUa, Serov VN, Troshin PV, Fillipov OS, Fillipovich GV. Klinicheskiye rekomendatsii “Rody odnoplodnyye, rodorazresheniye putem kesareva secheniya”. [Clinical guidelines “Singleton delivery, delivery by caesarean section”. Approved. Ministry of Health of the Russian Federation June 30, 2021 (CG 639-1). M.; 2021. https://cr.minzdrav.gov.ru/clin_recomend (access date: 11.01.2022). (In Russ.)
  25. Conroy K, Koenig AF, Yu YH, Courtney A, Lee HJ, Norwitz ER. Infectious morbidity after cesarean deli­very: 10 strategies to reduce risk. Rev Obstet Gynecol. 2012;5(2):69–77.
  26. Smaill FM, Gyte GM. Antibiotic prophylaxis versus no prophylaxis for preventing infection after caesarean section. Cochrane Database Syst Rev. 2010;1:CD007482. doi: 10.1002/14651858.CD007482.pub2.
  27. Obsa MS, Shanka GM, Menchamo MW, Fite RO, Awol MA. Factors associated with Apgar score among newborns delivered by Cesarean sections at Gandhi Memorial Hospital, Addis Ababa. J Pregnancy. 2020;2020:5986269. doi: 10.1155/2020/5986269.
  28. Bakar FT, Ozen A, Karatepe HÖ, Berber M, Ercan H. Impact of early weight loss on growth of Caesarean deli­vered babies: how long does it last? Child Care Health Dev. 2012;38(5):706–713. doi: 10.1111/j.1365-2214.2011.01291.x.

© 2022 Eco-Vector




This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies