Letters to the Editor
Valid Concerns
;
In the AWMF S3 guideline 015–084 on cesarean section, a recommendation is made for administering antibiotic prophylaxis before making a skin incision, but the advantage/benefit of such an approach is not unequivocal, considering at least two parties are affected (mother and baby/babies) (1). The guideline names pediatric abnormalities such as obesity, asthma, and type 1 diabetes in association with the procedure. These are complications that are also suspected to develop after the loss of the neonatal microbiome (2). If one considers this aspect in the context of the fact that for primary cesarean section the indication for preoperative antibiotic administration is scientifically not confirmed in any convincing way then doubts arise. One controlled trial from the US in 1999/2000 showed in women who had a cesarean section before going into labor, wound infections were confirmed in 0.96% of cases without prior prophylaxis and in 0.52% of subjects with prior prophylaxis (n=9432, OR 0.49, 95% CI: [0.28; 0.86]) (1). Does this difference justify the unquestionable harm to the neonatal microbiome?
The pediatric aspect should be discussed with the mother-to-be during preoperative counseling, especially preceding the comparatively risk-free primary or elective cesarean section. Omitting prophylaxis altogether would presumably be even better, but this seems forensically explosive in view of the AWMF recommendations, which are still being revised. Furthermore, the obligatory quality assurance for obstetric institutions opposes such an approach. For this reason, studies with a holistic research question that also includes the microbiome are not to be expected at the present time.
“Nihil nocere”—the situation is unsatisfactory from a medical professional perspective: well-founded concerns have been raised, and professionals are experiencing substantial uncertainty. So as to avoid having to enter one day into a forensic dispute because of this problem, a practical option is considered to be a decision made by the informed pregnant women in favor of, or against, antibiotic prophylaxis after counseling, with documented acceptance of the described respective risks.
DOI: 10.3238/arztebl.m2024.0117
Prof. Dr. med. habil. Prof. Dr. h.c. Udo B. Hoyme
Prof. Dr. med. habil. Werner Mendling
Ilm-Kreis-Kliniken
Arnstadt-Ilmenau gGmbH
Klinik für Frauenheilkunde und Geburtshilfe
Arnstadt
Udo.Hoyme@ilm-kreis-kliniken.de
Conflict of interest statement
The authors declare that no conflict of interest exists.
| 1. | Dinsmoor MJ, Gilbert S, Landon MB, et al.: Perioperative antibiotic prophylaxis for nonlaboring caesarean delivery. Obstet Gynecol 2009; 114: 752–6 CrossRef MEDLINE PubMed Central |
| 2. | Hoyme UB: Antimikrobielle Therapie und Mikrobiota. Gynäkologe 2019; 52: 16–24 CrossRef |
| 3. | Eckmann C, Aghdassi SJS, Brinkmann A, Pletz M, Rademacher J: Perioperative antibiotic prophylaxis—indications and modalities for the prevention of postoperative wound infection. Dtsch Arztebl Int 2024; 121: 233–42 VOLLTEXT |
