Analysis of the antibacterial drugs use and evaluation of the caesarean section outcomes in the ­regional perinatal center in two time periods with a 10-year interval

Abstract

Background. Infectious inflammatory complications that occur in women after caesarean section may affect the length of hospital stay. Timely drug therapy plays a major role in preventing the development of complications in the postoperative period.

Aim. To conduct a comparative pharmacoepidemiological analysis of antibiotics use and evaluate the surgery outcomes (on the part of the puerperal and the newborn) in women delivered by caesarean section.

Material and methods. A retrospective analysis of 1025 birth histories of women after planned and emergency caesarean section with a detailed assessment of the antibiotics use in two time periods with a 10-year interval: in 2007–2009 (first period, n=523) and in 2016–2017 (second period, n=502) was carried out. The operation outcomes, the length of hospital stay, the duration of antibiotics use were studied. The significance of differences in relative indicators was assessed by Pearson (χ2).

Results. The frequency of prescribing antibiotics in monotherapy for planned and emergency cesarean section in both time periods did not differ (p=0.858; p=0.726). There were more cases of using two antibiotics at the same time in the first period, both for planned (88 cases, 35.5%) and for emergency surgery (93 cases, 34%; p=0.001). Combinations of three antibiotics were used more frequently in the first period than in the second. The increase in body temperature after surgery (>37.5 °C) was statistically indistinguishable in two periods. The duration of hospital stay with primary antibiotic therapy in the first period was 6 bed-days, with primary antibiotic prophylaxis in the second period — 4 bed-days. Exacerbation of urinary tract infections during emergency and planned caesarean section was diagnosed 4 and 5 times more often in the first period than in the second. Outcome on the part of the newborn — an Apgar score of less than 7 points was more common with emergency intervention in the second period (10%) than in the first (3.5%; p=0.003).

Conclusion. In the first studied time period (2007–2009), with combined antibiotic therapy after caesarean section, a longer stay of women in the hospital, a higher frequency of urinary tract exacerbations in puerperas, and a better assessment of the condition of newborns according to the Apgar score were registered, compared with these indicators in the second time period (in 2016–2017), when antibiotic prophylaxis was predominantly used.

Keywords

pharmacoepidemiology / antibiotic prophylaxis / antibiotic therapy / maternal outcomes / neonatal outcomes / planned and emergency cesarean section

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