A Comparative Study of Intra-Incisional Antibiotic Infiltration and IV Prophylaxis in Reducing Pfannenstiel Wound Infections

Arfa Khalil; Kausar Masoom; Syed Azra; Najma Khoursheed; Sania Nasir; Sundas Satti; Aisha Sidiqqa; Samana Haider

doi:10.71104/jsogp.v14i2.623

Arfa Khalil Post Graduate Resident Gynae, Pakistan Institute of Medical Sciences, Islamabad
Kausar Masoom Associate Professor, Gynae MCH centre, Pakistan Institute of Medical Sciences, Islamabad
Syed Azra Senior registrar MCH centre PIMS
Najma Khoursheed Assistant Professor Gynae, Pakistan Institute of Medical Sciences, Islamabad
Sania Nasir Post Graduate Resident Gynae, Pakistan Institute of Medical Sciences, Islamabad
Sundas Satti Post Graduate Resident Gynae, Pakistan Institute of Medical Sciences, Islamabad
Aisha Sidiqqa Professor of Obs and Gynae, Bolan Medical College Quetta
Samana Haider Post Graduate Resident Gynae, Pakistan Institute of Medical Sciences, Islamabad

DOI: https://doi.org/10.71104/jsogp.v14i2.623

Abstract

Background: Surgical site infections (SSIs) following Pfannenstiel incision procedures remain a significant clinical challenge, with reported incidence rates of 5-20% despite systemic antibiotic prophylaxis. The anatomical location and frequent contamination from genitourinary flora make this incision particularly vulnerable to infection.

Objective: To compare the efficacy of three antibiotic administration strategies in preventing SSIs: conventional intravenous (IV) prophylaxis, intra-incisional infiltration, and a combined approach.

Methods: After taking ethical approval from the concerned institute, a prospective, triple-arm, randomized controlled trial was conducted at a tertiary care hospital from January to September 2021. Three hundred patients undergoing Pfannenstiel incision procedures were randomized to receive: Group A: IV ceftriaxone 1g, - Group B: Intra-incisional ceftriaxone 1g and Group C: Combined IV 500mg + intra-incisional 500mg ceftriaxone

Results: The intra-incisional group demonstrated superior outcomes with SSI rate of 6% vs 13% in IV group (p=0.024), Shorter mean hospital stay (3.1 vs 4.2 days) and Lower postoperative pain scores (VAS 3.1 vs 4.7). Microbiological analysis revealed Escherichia coli as the predominant pathogen (51.7%).

Conclusion: Intra-incisional antibiotic administration significantly reduces SSI risk and improves postoperative outcomes compared to IV prophylaxis. This method should be considered as a standard approach for Pfannenstiel incision procedures.