Single dose versus extended dose antibiotics in prevention of surgical site infection in elective caesarean section at a tertiary hospital in Kisumu-Kenya: a randomized controlled trial

Abstract

When compared to other surgical procedures overall, Caesarean section (CS) accounts for the most recorded cases of surgical site infection (SSI). Following CS, antibiotic prophylaxis usage has been proven to lower incidence of SSI in both high risk and low risk individuals. However, it is not obvious if either single dose (SD) or extended dose (ED) antibiotic prophylaxis make much difference in SSI prevention despite previous research emphasizing the importance of antibiotic prophylaxis in surgical procedures The main objective of this study was to compare the effectiveness of SD, and ED antibiotics in elective CS in prevention of SSI. This was an open label randomized control study carried out in 9 months period beginning March 2022 to December 2022 at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH). 150 consenting patients were randomly distributed into control and intervention arms. Subjects in booth groups received intravenous (IV) ceftriaxone one gram 30 minutes before operation; subjects in control arm received additional IV ceftriaxone and metronidazole for 48 hours then amoxicillin 500mg every 8 hours and metronidazole 500mg tablets for 5 days. The participants were followed up for evidence of SSIs for 4 weeks. Data was collected and recorded into an abstraction form during the period of follow up by the investigator and research assistant. The completed forms were received, checked for completeness, and keyed into the computer. The data was analyzed using Statistical Package for Social Sciences (SPSS) Version 25. Rate of SSI was assessed and compared across study arms. Patients ‘factors associated with infection rate were analyzed at bivariate levels using Chi square and Fisher’s exact test. Multivariate logistic regression test was further done to determine factors associated with SSI. All covariates with p-value <=0.05 at bivariate analysis were included in multivariate logistic regression with 95% confidence intervals were reported. Out of the 75 on SD arm, 2 (2.6%) developed SSI, whereas of the 75 on ED arm, 1 (1.3%) developed SSI. Patient factors such as age, income status, parity, level of education, indication for CS, type of incision, amount of blood loss, random blood sugar level prior to operation, white blood cell level, type of anesthesia did not have significant influence in development of SSI in both the trial arms during the twenty-eight days of follow up. The findings showed that there was no statistically significant difference in occurrence of post elective caesarian SSI between the SD and ED groups with a p value of 0.567 at 1 degree of freedom (df) with a 95% confidence interval (CI) of 0.533044 – 5.559 with relative risk (RR) of 0.493. In conclusion, SD prophylaxis is equally effective as ED prophylaxis in prevention of SSI in elective CS. This study recommends that in the absence of evidence of SSI, there is no justification for ED of antibiotics as SD is sufficient.