Infektprophylaxe bei Sectio – wie und wann?

Surgical site infections (SSIs) following cesarean section threaten women’s health, prolong hospitalization, and increase costs. Perioperative antibiotic prophylaxis (PAP) is a crucial component to prevent SSIs. Clinical studies have shown that administering PAP before skin incision significantly reduces the SSI rate compared to after cord clamping. Therefore, current international guidelines recommend the use of PAP before skin incision. Antibiotics administered preoperatively cross the placenta and temporarily result in therapeutic levels in the newborn. Hence, there has long been a debate on whether PAP should be given after cord clamping for the benefit of the child. Furthermore, the effect of a single PAP dose on the newborn’s microbiome has been inconsistent in studies, and data on long-term clinical effects are lacking. In settings with low SSI rates, discussions are ongoing about alternative approaches, such as PAP before skin incision only in the presence of risk factors or an informed decision by the patient on the time of administration following individual counseling. Implementing these approaches poses a challenge in everyday clinical practice.