Subscribe to RSS
Perioperative Antibiotic Choice in Labored versus Unlabored Cesareans and Risk of Postcesarean Infectious Morbidity
01 February 2017
15 July 2017
24 August 2017 (online)
Objective This study aims to estimate postcesarean infectious morbidity in women receiving perioperative β-lactam versus non-β-lactam antibiotics.
Methods We conducted a retrospective cohort analysis of the Maternal-Fetal Medicine Unit Cesarean Registry. The exposure was β-lactam perioperative antibiotics versus non-β-lactam regimens at cesarean delivery (CD). We stratified by labored versus unlabored CD. The primary composite outcome included wound infection, seroma, hematoma, endometritis, readmission due to wound complication, or debridement. Multivariable logistic regression estimated odds of wound complication by antibiotic regimen after adjusting for relevant confounders.
Results Our analysis included 43,735 women who delivered via CD, 48% following labor. In both groups, 95% of women received β-lactam antibiotics. In the labored CD group (n = 20,860), there was no significant difference in primary outcome by β-lactam versus non-β-lactam antibiotics (10.5 vs. 9.9%, p = 0.53). In the unlabored CD group (n = 22,875), women receiving non-β-lactam antibiotics were more likely to experience a wound complication compared with those in the β-lactam group (6.2 vs. 4.7%, p = 0.02, adjusted odds ratio: 1.39, 95% confidence interval: 1.08–1.80) after adjustment for clinical confounders.
Conclusion In unlabored CD, non-β-lactam antibiotics have a higher risk of wound complications compared with β-lactam regimens. Further study to optimize antibiotic prophylaxis for β-lactam allergic women undergoing unlabored CD is warranted.
This article was presented as an oral presentation at the 2016 Annual Meeting of the Infectious Diseases Society of Obstetrics and Gynecology, August 11–13, 2016, Annapolis, MD.
- 1 Hamilton BE, Hoyert DL, Martin JA, Strobino DM, Guyer B. Annual summary of vital statistics: 2010-2011. Pediatrics 2013; 131 (03) 548-558
- 2 Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol 2008; 29 (06) 477-484 , discussion 485–486
- 3 Smid MC, Kearney MS, Stamilio DM. Extreme obesity and postcesarean wound complications in the maternal-fetal medicine unit cesarean registry. Am J Perinatol 2015; 32 (14) 1336-1341
- 4 Stamilio DM, Scifres CM. Extreme obesity and postcesarean maternal complications. Obstet Gynecol 2014; 124 (2 Pt 1): 227-232
- 5 Smaill FM, Gyte GM. Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section. Cochrane Database Syst Rev 2010; (01) CD007482
- 6 American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 120: Use of prophylactic antibiotics in labor and delivery. Obstet Gynecol 2011; 117 (06) 1472-1483
- 7 Faro S, Martens MG, Hammill HA, Riddle G, Tortolero G. Antibiotic prophylaxis: is there a difference?. Am J Obstet Gynecol 1990; 162 (04) 900-907 , discussion 907–909
- 8 Sogn DD, Evans III R, Shepherd GM. , et al. Results of the National Institute of Allergy and Infectious Diseases Collaborative Clinical Trial to test the predictive value of skin testing with major and minor penicillin derivatives in hospitalized adults. Arch Intern Med 1992; 152 (05) 1025-1032
- 9 del Real GA, Rose ME, Ramirez-Atamoros MT. , et al. Penicillin skin testing in patients with a history of β-lactam allergy. Ann Allergy Asthma Immunol 2007; 98 (04) 355-359
- 10 Group IRFS. ; International Rheumatic Fever Study Group. Allergic reactions to long-term benzathine penicillin prophylaxis for rheumatic fever. Lancet 1991; 337 (8753): 1308-1310
- 11 Dash CH. Penicillin allergy and the cephalosporins. J Antimicrob Chemother 1975; 1 (3, Suppl): 107-118
- 12 Daulat S, Solensky R, Earl HS, Casey W, Gruchalla RS. Safety of cephalosporin administration to patients with histories of penicillin allergy. J Allergy Clin Immunol 2004; 113 (06) 1220-1222
- 13 Lee CE, Zembower TR, Fotis MA. , et al. The incidence of antimicrobial allergies in hospitalized patients: implications regarding prescribing patterns and emerging bacterial resistance. Arch Intern Med 2000; 160 (18) 2819-2822
- 14 Uppal S, Harris J, Al-Niaimi A. , et al. Prophylactic antibiotic choice and risk of surgical site infection after hysterectomy. Obstet Gynecol 2016; 127 (02) 321-329
- 15 Alfirevic Z, Gyte GM, Dou L. Different classes of antibiotics given to women routinely for preventing infection at caesarean section. Cochrane Database Syst Rev 2010; (10) CD008726
- 16 Faro S. Infectious disease relations to cesarean section. Obstet Gynecol Clin North Am 1988; 15 (04) 685-695
- 17 Burrows LJ, Meyn LA, Weber AM. Maternal morbidity associated with vaginal versus cesarean delivery. Obstet Gynecol 2004; 103 (5 Pt 1): 907-912
- 18 Faro S, Martens M, Hammill H, Phillips LE, Smith D, Riddle G. Ticarcillin/clavulanic acid versus clindamycin and gentamicin in the treatment of post-cesarean endometritis following antibiotic prophylaxis. Obstet Gynecol 1989; 73 (5 Pt 1): 808-812
- 19 Tita AT, Szychowski JM, Boggess K. , et al; C/SOAP Trial Consortium. Adjunctive azithromycin prophylaxis for cesarean delivery. N Engl J Med 2016; 375 (13) 1231-1241
- 20 Mackeen AD, Packard RE, Ota E, Berghella V, Baxter JK. Timing of intravenous prophylactic antibiotics for preventing postpartum infectious morbidity in women undergoing cesarean delivery. Cochrane Database Syst Rev 2014; (12) CD009516
- 21 Arroliga ME, Wagner W, Bobek MB, Hoffman-Hogg L, Gordon SM, Arroliga AC. A pilot study of penicillin skin testing in patients with a history of penicillin allergy admitted to a medical ICU. Chest 2000; 118 (04) 1106-1108
- 22 Macones GA, Cleary KL, Parry S. , et al. The timing of antibiotics at cesarean: a randomized controlled trial. Am J Perinatol 2012; 29 (04) 273-276
- 23 King EA, Challa S, Curtin P, Bielory L. Penicillin skin testing in hospitalized patients with β-lactam allergies: Effect on antibiotic selection and cost. Ann Allergy Asthma Immunol 2016; 117 (01) 67-71
- 24 Macy E. Penicillin skin testing in pregnant women with a history of penicillin allergy and group B streptococcus colonization. Ann Allergy Asthma Immunol 2006; 97 (02) 164-168