Antibioticoprofilaxia em cesariana: Fatores de risco associados à infecção de ferida cirúrgica e sepse neonatal

Background and objectives: Post-surgical site infection (SSI) is one of the major complications of cesarean section and antimicrobial preoperative prophylaxis is indicated before incision or after umbilical cord clamping. The aim of this study is to compare the SSI rates and neonatal sepsis during two different prophylaxis protocols. Methods: Prospective observational study, from 2012 to 2015, at a maternity of reference for high obstetrical risk assistance. All pregnant women who underwent cesarean section and their newborns were included. Information was obtained when they were contacted by telephone call and by medical records. Infection criteria followed National Healthcare Safety Network and Agencia Nacional de Vigilância Sanitaria recomendations. Analysis was performed in Statistical Package for Social Sciences . The study was approved by the Research Ethics Committee. Results: A total of 3.230 pregnant underwent cesarian-section. Of this total, 2.351 binomials mother-newborns (72.7%) were followed. When comparing event infection, considering the two periods of moment different prophylaxis (before or after cord clamp), there was no statistical difference for SSI (X 2 =1,98; p = 0.16) or neonatal sepsis (X 2 = 0.94; p = 0.33). No analyzed variable was associated with maternal SSI. However, lower maternal age (p <0.003), lower gestational age (p <0.001), chorioamnionitis (p = 0.001), maternal hypertensive emergency (p < 0.001), centralization of blood flow (p = 0.02), ASA classification ≥ 3 (p = 0.02), dystocia or induction failure (p = 0.003) were significantly associated to neonatal sepsis. Only lower gestational age was significant in multivariate analysis (p = 0.004). Conclusion : There was no negative impact on the clinical outcome of the newborn for the occurrence of sepsis. However, reduction of maternal SSI proportion was not observed and optimal time for antibiotic administration should be reevaluated.