Antibioticoprofilaxia em cesariana: Fatores de risco associados à infecção de ferida cirúrgica e sepse neonatal

Abstract

Justification and objectives: Post-surgical site infection (SSI) is one of the major complications of cesarean section and preoperative antimicrobial prophylaxis is indicated before the incision or after umbilical cord clamping. The aim of this study is to compare the SSI rates and neonatal sepsis with two different prophylaxis protocols. Methods: Prospective observational study, carried out 2012 to 2015, at a reference maternity hospital for high obstetric risk patients. All pregnant women who underwent cesarean section and their newborns were included. Information was obtained when they were contacted by telephone call and by medical records. Infection criteria followed National Healthcare Safety Network and Agência Nacional de Vigilância Sanitária recommendations. Analysis was performed using the Statistical Package for Social Sciences. The study was approved by the Research Ethics Committee. Results: A total of 3230 pregnant underwent cesareansections. Of this total, 2,351 mother-newborn binomials (72.7%) were followed. When comparing infection events, considering the two different prophylaxis moments (before or after cord clamping), there was no statistical difference for SSI (X2 =1,98; p = 0.16) or neonatal sepsis (X2 = 0.94; p = 0.33). No analyzed variable was associated with maternal SSI. However, lower maternal age (p <0.003), lower gestational age (p <0.001), chorioamnionitis (p = 0.001), maternal hypertensive emergency (p < 0.001), centralization of blood flow (p = 0.02), ASA classification ≥ 3 (p = 0.02), dystocia or induction failure (p = 0.003) were significantly associated to neonatal sepsis. Only lower gestational age was significant in the multivariate analysis (p = 0.004). Conclusion: There was no negative impact on the clinical outcome of the newborn regarding the occurrence of sepsis. However, reduction in maternal SSI proportion was not observed and optimal time for antibiotic administration should be reevaluated.