title: [What's the optimal time of cesarean section antibiotic prophylaxis, before skin incision or after umbilical cord clamping? A prospective randomized study].
abstract: OBJECTIVE
  To compare the effect of antibiotics prophylaxis within 30 mins before skin incision (A) and after umbilical cord clamping (C) on the incidence of postoperative infections in patients undergoing elective caesarean section at Farhat Hached university teaching hospital.
  
  
  METHODS
  We conducted a randomised clinical trial evaluating 279 patients undergoing elective caesarean section. Patients were randomly assigned a group number that allocated them to either arm of the study. They received the same prophylactic antibiotic (cefazol®2g) according to their allotment. They were followed up to detect infection up to 30 days postoperatively. The primary outcome was postoperative infection. The data collected were analysed with SPSS version 18.0 using univariate and bivariate analysis.
  
  
  RESULTS
  The risk of overall postoperative infection was not significantly lower when prophylaxis was given before skin incision (4.37 % (A) vs 9.85 % (C); P=0.07; OR=0.42 [0.15-1.12]). We also found wound infections to be significantly reduced in the pre-incision group (2.2 % [A] vs 8.45 % [C]; P=0.03; OR=0.24 [0.06-0.88]). However, there was no difference in the endometritis infectious. On the other hand, there was no negative impact on the neonatal features.
  
  
  CONCLUSIONS
  Giving prophylactic antibiotics before skin incision reduces risk of postoperative infection, in particular of wound infections.
authors.affiliation: Service de gynécologie obstétrique, CHU Faraht Hached de Sousse, université de Sousse, rue Mohamed Karoui, BP 4000, Sousse, Tunisie. Electronic address: khlifiabj@yahoo.fr.
authors.forename: A
authors.initials: A
authors.lastname: Khlifi
authors.affiliation: Service de gynécologie obstétrique, CHU Faraht Hached de Sousse, université de Sousse, rue Mohamed Karoui, BP 4000, Sousse, Tunisie.
authors.forename: M
authors.initials: M
authors.lastname: Kouira
authors.affiliation: Service de gynécologie obstétrique, CHU Faraht Hached de Sousse, université de Sousse, rue Mohamed Karoui, BP 4000, Sousse, Tunisie.
authors.forename: I
authors.initials: I
authors.lastname: Bannour
authors.affiliation: Service de gynécologie obstétrique, CHU Faraht Hached de Sousse, université de Sousse, rue Mohamed Karoui, BP 4000, Sousse, Tunisie.
authors.forename: F
authors.initials: F
authors.lastname: Hachani
authors.affiliation: Service C de gynécologie obstétrique, CMNT, université Elmanar de Tunis, Tunis, Tunisie.
authors.forename: M
authors.initials: M
authors.lastname: Kehila
authors.affiliation: Service d'anesthésie et de réanimation, CHU Farhat Hached de Sousse, université de Sousse, Sousse, Tunisie.
authors.forename: F
authors.initials: F
authors.lastname: Ferhi
authors.affiliation: Service d'anesthésie et de réanimation, CHU Farhat Hached de Sousse, université de Sousse, Sousse, Tunisie.
authors.forename: A
authors.initials: A
authors.lastname: Bouslama
authors.affiliation: Service d'anesthésie et de réanimation, CHU Farhat Hached de Sousse, université de Sousse, Sousse, Tunisie.
authors.forename: K
authors.initials: K
authors.lastname: Ben Jazia
authors.affiliation: Service de gynécologie obstétrique, CHU Faraht Hached de Sousse, université de Sousse, rue Mohamed Karoui, BP 4000, Sousse, Tunisie.
authors.forename: M
authors.initials: M
authors.lastname: Fekih
authors.affiliation: Service de gynécologie obstétrique, CHU Faraht Hached de Sousse, université de Sousse, rue Mohamed Karoui, BP 4000, Sousse, Tunisie.
authors.forename: H
authors.initials: H
authors.lastname: Khairi
mesh_terms: D000328:Adult; D019072:Antibiotic Prophylaxis / Q000379:methods* / Q000592:standards; D002585:Cesarean Section / Q000379:methods* / Q000592:standards; D004716:Endometritis / Q000517:prevention & control*; D005260:Female; D006801:Humans; D011183:Postoperative Complications / Q000517:prevention & control*; D013530:Surgical Wound Infection / Q000517:prevention & control; D013997:Time Factors
keywords: Antibioprophylaxie; Cesarean section; Césarienne; Endometritis; Endométrite; Infection postopératoire; Postoperative infection; Prophylactic antibiotics