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Adding metronidazole to kefazolin prophylaxis for caesarean sections did not reduce postpartum infections. This study found no significant difference in infection rates between groups, suggesting current prophylaxis strategies may need re-evaluation.

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Area of Science:

  • Obstetrics and Gynecology
  • Infectious Diseases
  • Surgical Prophylaxis

Background:

  • Caesarean sections carry a high risk of maternal and neonatal complications, including postpartum infections.
  • Pregnancy-related sepsis is a significant cause of maternal mortality, particularly in South Africa.
  • Optimizing prophylactic antibiotic regimens aims to reduce postpartum infections and sepsis following caesarean delivery.

Purpose of the Study:

  • To compare the efficacy of cefazolin alone versus cefazolin plus metronidazole for preventing postpartum infection in women undergoing caesarean section.
  • To evaluate the impact of extended-spectrum antibiotic prophylaxis on infection rates in caesarean deliveries.

Main Methods:

  • A randomized controlled trial was conducted at Kalafong Provincial Tertiary Hospital.
  • Patients undergoing caesarean section were randomized to receive either cefazolin alone (control) or cefazolin plus metronidazole (intervention).
  • Outcomes included surgical site infections, rates of laparotomy, and hysterectomy.

Main Results:

  • The overall surgical site infection rate was 5.64%, with no significant difference between the cefazolin alone group (5.33%) and the cefazolin plus metronidazole group (5.96%).
  • Secondary outcomes, including rates of laparotomy and hysterectomy, also showed no statistically significant differences between the two groups.
  • The study demonstrated no added benefit of metronidazole when combined with cefazolin for caesarean section prophylaxis.

Conclusions:

  • The addition of metronidazole to cefazolin prophylaxis for caesarean sections does not appear to reduce postpartum infection rates.
  • Postpartum infection is multifactorial, and strengthening sepsis care bundles may involve addressing various contributing factors.
  • Current evidence does not support the routine addition of metronidazole to cefazolin for prophylaxis in caesarean sections.