Is a single dose of commonly used antibiotics effective in preventing maternal infection after cesarean section? A network meta-analysis

• Published in: PloS one Vol. 17; no. 4; p. e0264438
• Main Authors: Huang, Ye, Yin, Xinbo, Wang, Xiaokai, Zhou, Fangyi, Cao, Xiaoxia, Han, Yeqiong, Sun, Shichang
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 06.04.2022; Public Library of Science (PLoS)
• Subjects: Anti-Bacterial Agents - therapeutic use; Antibiotics; Bias; Biology and Life Sciences; Cephalosporins; Cephalosporins - therapeutic use; Cesarean section; Cesarean Section - adverse effects; Clinical trials; Complications and side effects; Computer and Information Sciences; Disease prevention; Dosage and administration; Drug dosages; Emergency medical care; Endometritis; Endometritis - drug therapy; Evaluation; Female; Fever - drug therapy; Fever - etiology; Fever - prevention & control; Geriatrics; Gynecology; Health risks; Hospitals; Humans; Infection control; Infections; Medicine; Medicine and Health Sciences; Meta-analysis; Morbidity; Patient outcomes; Penicillin; Penicillins - therapeutic use; Physical Sciences; Placebos; Pregnancy; Research and Analysis Methods; Success; Systematic review; Womens health; Wound infection; Wound Infection - drug therapy; China; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0264438

This study aimed to compare the efficacy of different antibiotic classes and dosages in preventing maternal infection after cesarean delivery. Databases were searched for randomized controlled trials (RCTs) published between January 1980 and January 2021 on antibiotic use for the prevention of maternal infection after cesarean delivery. The outcomes were endometritis, febrile morbidity, and wound infection, reported as odds ratios (OR) and surface under the cumulative ranking curve analysis scores. A total of 31 RCTs met the inclusion criteria. In the network meta-analysis (NMA) for endometritis, pooled network OR values indicated that the following interventions were superior to placebo: cephalosporins (OR: 0.18, 95% credibility interval [CrI]: 0.07-0.45), penicillins (OR: 0.19, 95% CrI: 0.07-0.50), penicillins (multiple doses) (OR: 0.20, 95% CrI: 0.05-0.65), combination therapies (OR: 0.22, 95% CrI: 0.09-0.54), and cephalosporins (multiple doses) (OR: 0.25, 95% CrI: 0.08-0.74). In the NMA for febrile morbidity, placebo was more effective than the other interventions. In the NMA for wound infection, pooled network OR values indicated that the following interventions were superior to placebo: penicillin (OR: 0.14, 95% CrI: 0.05-0.37), cephalosporins (OR: 0.19, 95% CrI: 0.08-0.41), cephalosporins (multiple doses) (OR: 0.20, 95% CrI: 0.06-0.58), combination therapies (OR: 0.29, 95% CrI: 0.13-0.57), macrolides (OR: 0.33, 95% CrI: 0.15-0.74), and penicillins (multiple doses) (OR: 0.40, 95% CrI: 0.17-0.91). Compared with placebo, a single dose of commonly used antibiotics may prevent maternal infection after cesarean delivery. However, the incidence of febrile morbidity was not reduced.