Subcutaneous Fusidic Acid Instillation for Prophylaxis Against Surgical Site Infection in Elective Cesarean Section: A Randomized Controlled Trial

Abstract

There are many interventions advocated to reduce SSI, including preoperative assessment to optimize underlying disease such as diabetes mellitus, aseptic techniques in the operating theatre and the use of systemic prophylactic antibiotics. Amongst the many interventions advocated to prevent SSI, the effectiveness of pre-operative intravenous administration of antibiotic prophylaxis has been extensively studied and has been shown to be effective. Surgical practice often includes the use of topical or local antimicrobial agents applied to the operative site to minimize post-operative surgical infections, especially SSI. Compared with systemic antibiotic therapy, topical or local delivery of an antibiotic has many potential advantages, as well as some disadvantages. The benefits of local application include high and sustained concentrations at the site of infection where local physiological changes may hinder the efficacy of systemic antibiotics. Other benefits include the limited potential for systemic absorption and toxicity, reduced volumes of antibiotic use, and, possibly, less potential for the development of antibiotic resistance. This is a prospective study which carried out at Ain Shams University Maternity Hospital. A total of 150 pregnant women who was undergo elective caesarean sections included in our study. All the patients operated under full aseptic measures first by surgical hand scrub using standard 5 minutes surgical scrub using iodophor, hair at operative site clipped short with scissors if interfering with the operative procedure then cleaning the operative site with povidone-iodine scrub solution 7%, blotted with dry sterile towels then painted with an aqueous povidone-iodine solution 10%. All of them were given pre-operative antibiotics prophylaxis. Cefazolin is a first-generation cephalosporin and is a Pregnancy Category B drug. When given intravenously, its half-life is 1.8 hours. It provides good coverage for gram positive organisms and has modest gram negative coverage. In a 1999 guideline, the US Centers for Disease Control and Prevention recommended its use at Caesarean section. It is recommended that 1 to 2 grams should be administered intravenously not more than 30 minutes before the skin is cut. An additional dose can be considered if blood loss exceeds 1500 mL or at 4 hours if the procedure lasts more than 4 hours (i.e., up to 2 half-lives of the drug) (12). Out of the 150 patients, 75 patients were not have subcutaneous fusidic acid instilled before closing the skin followed by dry dressing (group N)while the other 75 patients (group F) have 5 drops of subcutaneous fusidic acid 10 mg instilled before closing the skin followed by dry dressing. The dressings of all the patients opened up on the third post-operative day and regularly followed up every week for 4 weeks for any wound infection. Any surgical site infection within the 30 days following surgery documented and classified according to Southampton wound grading system.