RESUMEN
Background: Post-operative infections in obstetrics and gynecological settings have been higher compared to other specialties. Women undergoing caesarean section have 5 to 20-fold greater risk for infection compared with vaginal delivery. Many studies reported antimicrobial prophylaxis prevent post-operative infections. Hence this study concentrates the evaluation of the prescribing antimicrobial use and to assess the frequency of post-operative morbidity related to infection in subjects undergoing caesarean section. The aim of the study was to analysis the effectiveness, prophylactic antibiotics (amoxicillin versus ceftriaxone) and to evaluate the post-operative (caesarean) infections in patients undergoing lower segment caesarean section (elective and emergency).Methods: This is a prospective observational study which assessed the effectiveness and use of prophylactic antibiotics in patients undergoing cesarean section at department of obstetrics and gynecology. The study was conducted over a period of one year.Results: The corresponding mean age of all the study population in amoxicillin group (n=113) was 56.5±28.5 and in ceftriaxone group (n=97) was 48.5±26.5 respectively. The participant who underwent previous cesarean section in amoxicillin group is 65.48% similarly in ceftriaxone group is 47.42%. The patients with fetal distress in ceftriaxone group are 14.77% and in amoxicillin group is 8.92%. Failed induction in amoxicillin group is 9.82% and in ceftriaxone group is 6.81%. The number of days in hospital stay in amoxicillin group is 42.42% and in ceftriaxone group is 45.94%. The post-operative complications in amoxicillin group reported, with Febrile Illness are 40% and wound Infection is 60%.Conclusions: Administration of pre-operative antibiotics significantly reduce post-operative infections. Use of ceftriaxone as a prophylactic antibiotic in patients undergoing lower segment caesarean section (elective and emergency) is more effective than Amoxicillin in preventing post-operative infections.
RESUMEN
La incidencia de fiebre en el postoperatorio varía ampliamente. En la cirugía limpia y la limpia-contaminada, la fiebre no infecciosa es más frecuente que la infecciosa. Fueron estudiados prospectivamente 303 pacientes operados en forma programada de cirugía ortopédica y urológica. Se investigó la incidencia de fiebre postoperatoria, su etiología, la relación entre el momento de su aparición y su origen y la utilidad del pedido empírico de estudios para determinar infección postoperatoria. El 14% (42/303) de los pacientes tuvieron fiebre postoperatoria. En el 81% (34/42) su etiología fue no infecciosa y en el 19% (8/42) infecciosa. Su origen fue siempre no infeccioso dentro de las primeras 48 horas del postoperatorio (p<0.001). A 19 pacientes con fiebre después de las 48 horas y examen clínico normal, se les realizó radiografía de tórax, hemocultivos (2) y cultivo de orina. Las radiografías de tórax fueron normales en todos los casos, fueron positivos 4 urocultivos (21%, IC 95%: 6-45) y un hemocultivo (5%, IC 95%: 0.1-26). Siete pacientes tuvieron infecciones postoperatorias sin fiebre. La causa de fiebre postoperatoria más frecuente fue no infecciosa, causada por respuesta normal inflamatoria al trauma quirúrgico. La realización de estudios de rutina en pacientes con examen clínico normal y fiebre posterior a las 48 horas, de acuerdo a lo observado en este estudio, no permite sacar conclusiones definitivas. El diagnóstico de las infecciones postoperatorias se basó en el seguimiento clínico- quirúrgico y en la interpretación de los síntomas y signos del paciente.
Post-operative fever incidence varies widely. In clean and clean-contaminated surgery the non-infectious fever is more frequent than the infectious fever. We performed a prospective study including 303 patients who underwent orthopedic and urologic elective surgery. The aims of our study were to investigate the incidence of post-operative fever, its etiology, the relationship between time of onset and the etiology, and the usefulness of extensive fever work-up to determine post-operative infection. The incidence of post-operative fever was 14% (42/303) of which 81% (34/42) was noninfectious and 19% (8/42) was infectious. The etiology of the fever in the first 48 hours after surgery was always non-infectious (p<0.001). An extensive fever work-up was performed in patients who presented fever only after the initial 48 hours of surgery with normal physical examination (n=19) consisting of chest x-ray, blood (2) and urine cultures. The chest x-ray was normal in all the patients, the urine cultures were positive in four cases (21%, IC 95%: 6-45) and the blood cultures in only one case (5%, IC 95%: 0.1-26). Seven patients had post-operative infections without fever as a clinical sign. The most frequently observed etiology of post-operative fever was non-infectious, related to the normal inflammatory host response to surgery. Based on the present results, the extensive fever work-up performed to investigate post-operative infection does not seem to be a useful tool. The diagnosis of post-operative infection was based on clinical follow up and the correct interpretation of the patient's symptoms and signs.