Retrospective audit on outcomes of post caesarean section sepsis after additional azithromycin to the standard antibiotic at Tygerberg hospital, Cape Town
Date
2023-12
Journal Title
Journal ISSN
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Publisher
Stellenbosch : Stellenbosch University
Abstract
ENGLISH ABSTRACT: Background Surgical site infections (SSI) and endometritis are important causes of post caesarean delivery (CD) morbidity and mortality. They lead to prolonged hospital stay and increase in hospital expenditure. The global rate of SSI is 3-15% with the change in incidence being attributed to changes in population traits, risk factors, perioperative practices and time taken from the procedure. There is currently little clinical data on the incidence of post CD in the South African setting. The commonest organisms associated are Staphylococcus aureus, E. coli, Pseudomonas, Proteus mirabilis and Mycoplasma species. Some of the identifiable risk factors are prolonged labour, emergency CD, multiple vaginal examinations during labour, diabetes mellitus or high Body Mass Index (BMI). With the use of the standard antibiotic prophylaxis, the incidence of post CD sepsis remains high. With dual antibiotic prophylaxis (azithromycin 500mg IV in addition to the standard cephazolin) there is a 60% reduction in post CD sepsis with no adverse neonatal outcomes. Single agent pre-operative prophylaxis with a first-generation cephalosporin (e.g. cefazolin) was the standard of care during 2017, when a retrospective folder review showed a cumulative incidence for post-CS sepsis to be 4.69%. Dual prophylaxis became the standard of care during 2019 with its inclusion in the National Essential Medicine List. This was introduced at Tygerberg Hospital in September 2020. Aim To perform an audit of post caesarean section sepsis after implementation of the additional azithromycin to standard antibiotic protocol at Tygerberg hospital, Cape Town; to monitor adherence to this new protocol as well as to determine the incidence of post-CD sepsis. Methods 3 | Page A retrospective study was conducted on all pregnant women undergoing CD at Tygerberg hospital in from 01 September 2021- 30 November 2021. Records of the cases of the patients were retrieved from the Electronic Content Management (ECM) and followed up to 30 days after delivery to determine the rate of post-CD sepsis. Results A total of 457 records were audited, with 16 women identified with post CD sepsis (a hospital rate of 3.5%). This was 18% lower than the rate reported prior to dual prophylaxis (4.69%). The risk factors identified to be significantly associated with post CD sepsis were number of vaginal examinations >5 (p = 0.007), duration of active labour (p = 0.011), labour mechanism (p = 0.009) and noticeable intra-operative findings including difficult haemostasis and adhesiolysis (p= 0.003). Conclusion Addition of azithromycin to the standard antibiotic reduces the rate of post CD sepsis. Multiple vaginal examinations, duration of active labour, emergency CD and specific intraoperative findings were identifiable risk factors for post CD sepsis.
AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar.
AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar.
Description
Thesis (MSc)--Stellenbosch University, 2023.