Efficacy of antimicrobials in the prevention of postpartum infection after vaginal delivery: overview of systematic reviews_Chinese Journal of Evidence-Based Medicine

Authors：

LI Xiaorang ¹ ,  ZHANG Jiaxing ² , ZHAO Huaye ² , ZHANG Rui ² , HU Linfang ² , WANG Jiaxue ² , LAN Junjie ² , SUN Shuimei ² , TAN Songsong ³ , CAO Jinyong ⁴

1. College of Pharmacy, Guizhou University of Traditional Chinese Medicine, Guiyang 550002, P. R. China;
2. Department of Pharmacy, Guizhou Provincial People's Hospital, Guiyang 550002, P. R. China;
3. Medical Insurance Department, Guizhou Provincial People's Hospital, Guiyang 550002, P. R. China;
4. Department of Endoscopy, Guizhou Provincial People's Hospital, Guiyang 550002, P. R. China;

Corresponding author：

ZHANG Jiaxing, Email: zjx19870619@126.com

Keywords：

Vaginal delivery; Antibiotic prophylaxis; Overview of systematic reviews; Outcome indicator item pool; Core outcome set

DOI：

10.7507/1672-2531.202308023

Video：

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Objective To overview of systematic reviews of the efficacy and safety of antimicrobials in the prevention of postpartum infection after vaginal delivery, and to provide evidence for the rational use of antimicrobials. Methods The CNKI, WanFang Data, VIP, PubMed, Embase, and Cochrane Library databases were searched to collect systematic reviews/meta-analyses on antibiotic prophylaxis for transvaginal delivery from inception to June 25, 2023. The data of the included systematic reviews were extracted by 2 investigators independently, and the methodological quality, risk of bias, and report quality were evaluated by AMSTAR 2.0 scale, ROBIS tool, and PRISMA, respectively. And a pool of outcomes for assessing the effectiveness of antimicrobials in prevention of postpartum infection after transvaginal delivery was developed. Results A total of 7 systematic reviews were included. And the AMSTAR 2.0 indicated that most studies (5/7) were from very low quality to low quality. The ROBIS tool showed 3 studies with low risk of bias, 3 with high risk of bias, and 1 with unclear risk of bias. The results of the PRISMA statement showed that the included system evaluation reports were relatively complete. The present evidence showed that prophylactic use of antimicrobials may be beneficial and recommended in women with Ⅲ-Ⅳ perineal fissures, with no significant benefit in women with manual placenta removal, but prophylactic use of antimicrobials was recommended considering their invasive nature, but it was controversial whether antimicrobials should be used in the categories of vaginal assisted delivery, perineal lateralization, and spontaneous delivery (without complications). Conclusion Antimicrobial prophylaxis may not be recommended for all the pregnant women undergoing vaginal delivery to prevent the postpartum infection, but considering the low methodological quality of the included systematic review and the inconsistent outcomes in this field, the conclusion should be further verified by future research with high-quality.

Citation： LI Xiaorang, ZHANG Jiaxing, ZHAO Huaye, ZHANG Rui, HU Linfang, WANG Jiaxue, LAN Junjie, SUN Shuimei, TAN Songsong, CAO Jinyong. Efficacy of antimicrobials in the prevention of postpartum infection after vaginal delivery: overview of systematic reviews. Chinese Journal of Evidence-Based Medicine, 2024, 24(3): 303-311. doi: 10.7507/1672-2531.202308023 Copy

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2.	Say L, Chou D, Gemmill A, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health, 2014, 2(6): e323-e333.
3.	Yokoe DS, Christiansen CL, Johnson R, et al. Epidemiology of and surveillance for postpartum infections. Emerg Infect Dis, 2001, 7(5): 837-841.
4.	Acosta CD, Harrison DA, Rowan K, et al. Maternal morbidity and mortality from severe sepsis: a national cohort study. BMJ Open, 2016, 6(8): e012323.
5.	Hussein J, Walker L. Puerperal sepsis in low and middle income settings: past, present and future. 2010.
6.	黄柳鲜, 刘凤媛, 丁丽鲜. 单剂量阿莫西林-克拉维酸钾预防分娩后阴道感染及感染因素. 中国计划生育学杂志, 2020, 28(9): 1402-1406, 1411.
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24.	郑彩虹, 汪凤梅, 赵梦丹, 等. 妇产科围手术期抗菌药物预防使用指导方案. 中国药学杂志, 2021, 56(3): 250-256.
25.	Ota E, Chibueze CE, Bonet M, et al. Antibiotic prophylaxis for uncomplicated vaginal birth: a systematic review of randomized and non-randomized studies. Cochrane Database Syst Rev, 2015, (1): CD002250.
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27.	Committee on Practice Bulletins-Obstetrics. ACOG practice bulletin no. 199: use of prophylactic antibiotics in labor and delivery. Obstet Gynecol, 2018, 132(3): e103-e119.
28.	Perry R, Whitmarsh A, Leach V, et al. A comparison of two assessment tools used in overviews of systematic reviews: ROBIS versus AMSTAR-2. Syst Rev, 2021, 10(1): 273.
29.	陶欢, 杨乐天, 平安, 等. 随机或非随机防治性研究系统评价的质量评价工具AMSTAR2解读. 中国循证医学杂志, 2018, 18(1): 101-108.
30.	The COMET Initiative. Search the COMET Database.
31.	李慧敏, 杨伟, 章轶立, 等. 中医药治疗绝经后骨质疏松症随机对照试验结局指标的现状分析. 中国中药杂志, 2021, 46(16): 4274-4286.
32.	Dol J, Hughes B, Bonet M, et al. Timing of maternal mortality and severe morbidity during the postpartum period: a systematic review. JBI Evid Synth, 2022, 20(9): 2119-2194.
33.	Chalmers I, Glasziou P. Avoidable waste in the production and reporting of research evidence. Lancet, 2009, 374(9683): 86-89.
34.	Hirsch BR, Califf RM, Cheng SK, et al. Characteristics of oncology clinical trials: insights from a systematic analysis of ClinicalTrials. gov. JAMA Intern Med, 2013, 173(11): 972-979.

1. Woodd SL, Montoya A, Barreix M, et al. Incidence of maternal peripartum infection: a systematic review and meta-analysis. PLoS Med, 2019, 16(12): e1002984.
2. Say L, Chou D, Gemmill A, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health, 2014, 2(6): e323-e333.
3. Yokoe DS, Christiansen CL, Johnson R, et al. Epidemiology of and surveillance for postpartum infections. Emerg Infect Dis, 2001, 7(5): 837-841.
4. Acosta CD, Harrison DA, Rowan K, et al. Maternal morbidity and mortality from severe sepsis: a national cohort study. BMJ Open, 2016, 6(8): e012323.
5. Hussein J, Walker L. Puerperal sepsis in low and middle income settings: past, present and future. 2010.
6. 黄柳鲜, 刘凤媛, 丁丽鲜. 单剂量阿莫西林-克拉维酸钾预防分娩后阴道感染及感染因素. 中国计划生育学杂志, 2020, 28(9): 1402-1406, 1411.
7. Dunk SA, Owen J, Lu MY, et al. Operative vaginal delivery as an independent risk factor for maternal postpartum infectious morbidity. Am J Obstet Gynecol MFM, 2022, 4(6): 100705.
8. World Health Organization. WHO recommendations for prevention and treatment of maternal peripartum infections. World Health Organization, 2016.
9. World Health Organization. WHO recommendation on routine antibiotic prophylaxis for women undergoing operative vaginal birth. 2021.
10. Kirkham JJ, Gorst S, Altman DG, et al. Core outcome set-standards for reporting: the cos-star statement. PLoS Med, 2016, 13(10): e1002148.
11. Page MJ, Moher D, Bossuyt PM, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ, 2021, 372: n160.
12. Atkins D, Best D, Briss PA, et al. Grading quality of evidence and strength of recommendations. BMJ, 2004, 328(7454): 1490.
13. Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ, 2017, 358: j4008.
14. 张方圆, 沈傲梅, 曾宪涛, 等. 系统评价方法学质量评价工具AMSTAR2解读. 中国循证心血管医学杂志, 2018, 10(1): 14-18.
15. Whiting P, Savović J, Higgins JP, et al. ROBIS: a new tool to assess risk of bias in systematic reviews was developed. J Clin Epidemiol, 2016, 69: 225-234.
16. 丁泓帆, 吴琼芳, 杨楠, 等. 评估系统评价偏倚风险的ROBISIS工具实例解读. 中国循证医学杂志, 2016, 16(1): 115-121.
17. Bonet M, Ota E, Chibueze CE, et al. Routine antibiotic prophylaxis after normal vaginal birth for reducing maternal infectious morbidity. Cochrane Database Syst Rev, 2017, (11): CD012137.
18. Liabsuetrakul T, Choobun T, Peeyananjarassri K, et al. Antibiotic prophylaxis for operative vaginal delivery. Cochrane Database Syst Rev, 2020, (3): CD004455.
19. Berhan Y, Kirba S, Gebre A. Still No substantial evidence to use prophylactic antibiotic at operative vaginal delivery: systematic review and meta-analysis. Obstet Gynecol Int, 2020, 2020: 1582653.
20. 白雪, 杨友运, 韩枫, 等. 会阴侧切术预防性应用抗菌药物效果的系统评价. 中国医药导报, 2018, 15(31): 146-150.
21. Bonet M, Ota E, Chibueze CE, et al. Antibiotic prophylaxis for episiotomy repair following vaginal birth. Cochrane Database Syst Rev, 2017, (11): CD012136.
22. Chibueze EC, Parsons AJ, Ota E, et al. Prophylactic antibiotics for manual removal of retained placenta during vaginal birth: a systematic review of observational studies and meta-analysis. BMC Pregnancy Childbirth, 2015, 15: 313.
23. Buppasiri P, Lumbiganon P, Thinkhamrop J, et al. Antibiotic prophylaxis for third- and fourth-degree perineal tear during vaginal birth. Cochrane Database Syst Rev, 2014, (10): CD005125.
24. 郑彩虹, 汪凤梅, 赵梦丹, 等. 妇产科围手术期抗菌药物预防使用指导方案. 中国药学杂志, 2021, 56(3): 250-256.
25. Ota E, Chibueze CE, Bonet M, et al. Antibiotic prophylaxis for uncomplicated vaginal birth: a systematic review of randomized and non-randomized studies. Cochrane Database Syst Rev, 2015, (1): CD002250.
26. Oteo J, Campos J, Lázaro E, et al. Increased amoxicillin-clavulanic acid resistance in Escherichia coli blood isolates, Spain. Emerg Infect Dis, 2008, 14(8): 1259-1262.
27. Committee on Practice Bulletins-Obstetrics. ACOG practice bulletin no. 199: use of prophylactic antibiotics in labor and delivery. Obstet Gynecol, 2018, 132(3): e103-e119.
28. Perry R, Whitmarsh A, Leach V, et al. A comparison of two assessment tools used in overviews of systematic reviews: ROBIS versus AMSTAR-2. Syst Rev, 2021, 10(1): 273.
29. 陶欢, 杨乐天, 平安, 等. 随机或非随机防治性研究系统评价的质量评价工具AMSTAR2解读. 中国循证医学杂志, 2018, 18(1): 101-108.
30. The COMET Initiative. Search the COMET Database.
31. 李慧敏, 杨伟, 章轶立, 等. 中医药治疗绝经后骨质疏松症随机对照试验结局指标的现状分析. 中国中药杂志, 2021, 46(16): 4274-4286.
32. Dol J, Hughes B, Bonet M, et al. Timing of maternal mortality and severe morbidity during the postpartum period: a systematic review. JBI Evid Synth, 2022, 20(9): 2119-2194.
33. Chalmers I, Glasziou P. Avoidable waste in the production and reporting of research evidence. Lancet, 2009, 374(9683): 86-89.
34. Hirsch BR, Califf RM, Cheng SK, et al. Characteristics of oncology clinical trials: insights from a systematic analysis of ClinicalTrials. gov. JAMA Intern Med, 2013, 173(11): 972-979.

Chinese Journal of Evidence-Based Medicine

Efficacy of antimicrobials in the prevention of postpartum infection after vaginal delivery: overview of systematic reviews

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