Pre- and Postoperative Antibiotics in Cesarean Sections: An Analysis of Therapeutic Approaches in Kenya

Author(s):
Chandler Hinson; Robert Sawyer

Background:

The administration of antibiotics during cesarean section procedures represents a critical component of surgical practice aimed at preventing surgical site infections (SSIs) and associated complications. In Kenya, where maternal healthcare is a pivotal public health concern, understanding the efficacy and appropriateness of antibiotic prophylaxis in cesarean sections is of paramount importance. However, there is a lack of comprehensive research on the specific types of antibiotics employed for prophylactic purposes in this region.

Hypothesis:

This study seeks to address this gap by understanding antibiotic prophylaxis practices and the classes of antibiotics utilized for prophylaxis during cesarean sections in Kenya.

Methods:

We conducted a cross-sectional survey on infection prevention and control (IPC) practices by adapting the World Health Organization IPC Assessment Framework. One component of this survey included questions on antibiotic prophylaxis for cesarean sections (CS). Purposive sampling was used to identify 23 primary and secondary hospitals, across 7 counties in Kenya that provided CS. Data was collected from March to April 2019.

Results:

All of the facilities (23) utilized systematic antibiotic prophylaxis. 78.2% (18) use pre-operative systemic antibiotic prophylaxis while 100% use post-operative antibiotic prophylaxis. The average number of days for systemic post-operative antibiotic prophylaxis was 3.87 days (range 2 – 7 days). The most common post-operative antibiotics used were ceftriaxone (91.3%), metronidazole (82.6%), and gentamicin (26.1%).

In addition to systemic antibiotics, 91.3% (21) give oral antibiotics as additional post-operative prophylaxis. Within oral antibiotics, the average number of days for prophylaxis is 5.6 (range 3-8). The most common antibiotics used were metronidazole (82.6%), Augmentin (60.9%), and ceftriaxone (13.0%).

Conclusions:

Current American College of Obstetrician and Gynecologist (ACOG) recommendations include antibiotic prophylaxis given to all women undergoing cesarean delivery within 60 minutes prior to incision. First line recommendations are a single dose of a first-generation cephalosporin. ACOG doesn’t recommend post-operative antibiotics unless the delivering mother is high risk for infection. This study shows guideline driven antibiotic practices aren’t being utilized at district hospitals in Kenya, increasing the risk for the growth of antibiotic resistance. Future approaches should work in partnership with these facilities to discourage the over-use of these antibiotics when not warranted, reducing antimicrobial resistance pressure within this area.