Download PDF
CC BY-NC-ND 4.0 · AJP Rep 2020; 10(02): e155-e158
DOI: 10.1055/s-0040-1709513
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Antibiotic Prophylaxis Trials in Obstetrics: A Call for Pediatric Collaboration

Rodney A. McLaren
1   Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
,
Fouad Atallah
1   Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
,
Howard Minkoff
1   Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
2   Department of Obstetrics and Gynecology, SUNY Downstate Medical Center, Brooklyn, New York
› Author Affiliations
Further Information

Publication History

29 December 2019

05 March 2020

Publication Date:
15 April 2020 (online)

   Permissions and Reprints

Abstract

Surgical site infections are common complications of cesarean delivery. Many recent studies, including meta-analyses, have assessed the efficacy of antibiotic prophylaxis. Those articles have demonstrated that preincision antibiotic prophylaxis reduces the incidence of surgical site infections postcesarean, and that the use of adjunctive azithromycin further reduces infection after nonelective cesarean deliveries. However, long-term effects of fetal exposure to antibiotic prophylaxis—including asthma, obesity, and alterations in microbiota—have also been demonstrated. We suggest that while studies of optimal antibiotic regimens proceed, considerations of the potential risks to the neonate should be factored into discussions of benefits and burdens.

Keywords

antibiotic prophylaxis - cesarean delivery - asthma - childhood obesity - microbiota - neonatal microbiome
 

  • References

  • 1 Boyle A, Reddy UM. Epidemiology of cesarean delivery: the scope of the problem. Semin Perinatol 2012; 36 (05) 308-314
    CrossrefPubMedGoogle Scholar
  • 2 Costantine MM, Rahman M, Ghulmiyah L. , et al. Timing of perioperative antibiotics for cesarean delivery: a metaanalysis. Am J Obstet Gynecol 2008; 199 (03) 301.e1-301.e6
    CrossrefPubMedGoogle Scholar
  • 3 Conroy K, Koenig AF, Yu YH, Courtney A, Lee HJ, Norwitz ER. Infectious morbidity after cesarean delivery: 10 strategies to reduce risk. Rev Obstet Gynecol 2012; 5 (02) 69-77
    PubMedGoogle Scholar
  • 4 Scifres CM, Leighton BL, Fogertey PJ, Macones GA, Stamilio DM. Supplemental oxygen for the prevention of postcesarean infectious morbidity: a randomized controlled trial. Am J Obstet Gynecol 2011; 205 (03) 267.e1-267.e9
    CrossrefPubMedGoogle Scholar
  • 5 Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. BJOG 2012; 119 (11) 1324-1333
    CrossrefPubMedGoogle Scholar
  • 6 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
    CrossrefPubMedGoogle Scholar
  • 7 Caissutti C, Saccone G, Zullo F. , et al. Vaginal cleansing before cesarean delivery: a systematic review and meta-analysis. Obstet Gynecol 2017; 130 (03) 527-538
    CrossrefPubMedGoogle Scholar
  • 8 La Rosa M, Jauk V, Saade G. , et al; Cesarean Section Optimal Antibiotic Prophylaxis Trial Consortium. Institutional protocols for vaginal preparation with antiseptic solution and surgical site infection rate in women undergoing cesarean delivery during labor. Obstet Gynecol 2018; 132 (02) 371-376
    CrossrefPubMedGoogle Scholar
  • 9 Harper LM, Kilgore M, Szychowski JM, Andrews WW, Tita ATN. Economic evaluation of adjunctive azithromycin prophylaxis for cesarean delivery. Obstet Gynecol 2017; 130 (02) 328-334
    CrossrefPubMedGoogle Scholar
  • 10 Blaser MJ. Our missing microbes: short-term antibiotic courses have long-term consequences. Cleve Clin J Med 2018; 85 (12) 928-930
    CrossrefPubMedGoogle Scholar
  • 11 Rodriguez J, Jordan S, Mutic A, Thul T. The neonatal microbiome: implications for neonatal intensive care unit nurses. MCN Am J Matern Child Nurs 2017; 42 (06) 332-337
    CrossrefPubMedGoogle Scholar
  • 12 Leis JA, Soong C. De-adoption of routine urine culture testing-a call to action. JAMA Intern Med 2019
    PubMedGoogle Scholar
  • 13 Puopolo KM, Lynfield R, Cummings JJ. ; COMMITTEE ON FETUS AND NEWBORN; COMMITTEE ON INFECTIOUS DISEASES. Management of infants at risk for group B streptococcal disease. Pediatrics 2019; 144 (02) e20191881
    CrossrefPubMedGoogle Scholar
  • 14 Knight M, Chiocchia V, Partlett C. , et al; ANODE collaborative group. Prophylactic antibiotics in the prevention of infection after operative vaginal delivery (ANODE): a multicentre randomised controlled trial. Lancet 2019; 393 (10189): 2395-2403
    CrossrefPubMedGoogle Scholar
  • 15 Tamburini S, Shen N, Wu HC, Clemente JC. The microbiome in early life: implications for health outcomes. Nat Med 2016; 22 (07) 713-722
    CrossrefPubMedGoogle Scholar
  • 16 Jiménez E, Marín ML, Martín R. , et al. Is meconium from healthy newborns actually sterile?. Res Microbiol 2008; 159 (03) 187-193
    CrossrefPubMedGoogle Scholar
  • 17 Cox LM, Yamanishi S, Sohn J. , et al. Altering the intestinal microbiota during a critical developmental window has lasting metabolic consequences. Cell 2014; 158 (04) 705-721
    CrossrefPubMedGoogle Scholar
  • 18 Corvaglia L, Tonti G, Martini S. , et al. Influence of intrapartum antibiotic prophylaxis for group B Streptococcus on gut microbiota in the first month of life. J Pediatr Gastroenterol Nutr 2016; 62 (02) 304-308
    CrossrefPubMedGoogle Scholar
  • 19 Aloisio I, Mazzola G, Corvaglia LT. , et al. Influence of intrapartum antibiotic prophylaxis against group B Streptococcus on the early newborn gut composition and evaluation of the anti-Streptococcus activity of Bifidobacterium strains. Appl Microbiol Biotechnol 2014; 98 (13) 6051-6060
    PubMedGoogle Scholar
  • 20 Mazzola G, Murphy K, Ross RP. , et al. Early gut microbiota perturbations following intrapartum antibiotic prophylaxis to prevent group B streptococcal disease. PLoS One 2016; 11 (06) e0157527
    CrossrefPubMedGoogle Scholar
  • 21 Zimmermann P, Curtis N. Effect of intrapartum antibiotics on the intestinal microbiota of infants: a systematic review. Arch Dis Child Fetal Neonatal Ed 2020; 105 (02) 201-208
    CrossrefPubMedGoogle Scholar
  • 22 Ahmadizar F, Vijverberg SJH, Arets HGM. , et al. Early life antibiotic use and the risk of asthma and asthma exacerbations in children. Pediatr Allergy Immunol 2017; 28 (05) 430-437
    CrossrefPubMedGoogle Scholar
  • 23 Yoshida S, Ide K, Takeuchi M, Kawakami K. Prenatal and early-life antibiotic use and risk of childhood asthma: a retrospective cohort study. Pediatr Allergy Immunol 2018; 29 (05) 490-495
    CrossrefPubMedGoogle Scholar
  • 24 Kashanian M, Mohtashami SS, Bemanian MH, Moosavi SAJ, Moradi Lakeh M. Evaluation of the associations between childhood asthma and prenatal and perinatal factors. Int J Gynaecol Obstet 2017; 137 (03) 290-294
    CrossrefPubMedGoogle Scholar
  • 25 Dom S, Droste JH, Sariachvili MA. , et al. Pre- and post-natal exposure to antibiotics and the development of eczema, recurrent wheezing and atopic sensitization in children up to the age of 4 years. Clin Exp Allergy 2010; 40 (09) 1378-1387
    CrossrefPubMedGoogle Scholar
  • 26 Sariachvili M, Droste J, Dom S. , et al. Is breast feeding a risk factor for eczema during the first year of life?. Pediatr Allergy Immunol 2007; 18 (05) 410-417
    CrossrefPubMedGoogle Scholar
  • 27 Tsakok T, McKeever TM, Yeo L, Flohr C. Does early life exposure to antibiotics increase the risk of eczema? A systematic review. Br J Dermatol 2013; 169 (05) 983-991
    CrossrefPubMedGoogle Scholar
  • 28 Mueller NT, Whyatt R, Hoepner L. , et al. Prenatal exposure to antibiotics, cesarean section and risk of childhood obesity. Int J Obes 2015; 39 (04) 665-670
    CrossrefPubMedGoogle Scholar
  • 29 Grimes DA, Schulz KF. False alarms and pseudo-epidemics: the limitations of observational epidemiology. Obstet Gynecol 2012; 120 (04) 920-927
    CrossrefPubMedGoogle Scholar
  • 30 Simioni J, Hutton EK, Gunn E. , et al. A comparison of intestinal microbiota in a population of low-risk infants exposed and not exposed to intrapartum antibiotics: the baby & microbiota of the intestine cohort study protocol. BMC Pediatr 2016; 16 (01) 183
    CrossrefPubMedGoogle Scholar
  • 31 Cawley J, Meyerhoefer C. The medical care costs of obesity: an instrumental variables approach. J Health Econ 2012; 31 (01) 219-230
    CrossrefPubMedGoogle Scholar
  • 32 Yatsunenko T, Rey FE, Manary MJ. , et al. Human gut microbiome viewed across age and geography. Nature 2012; 486 (7402): 222-227
    CrossrefPubMedGoogle Scholar
  • 33 Ben Shoham A, Bar-Meir M, Isocovich A, Samueloff A, Wiener-Well Y. Timing of antibiotic prophylaxis in cesarean section: retrospective, difference-in-differences estimation of the effect on surgical-site-infection. J Matern Fetal Neonatal Med 2019; 32 (05) 804-808
    CrossrefPubMedGoogle Scholar
  • 34 Valent AM, DeArmond C, Houston JM. , et al. Effect of post-cesarean delivery oral cephalexin and metronidazole on surgical site infection among obese women: a randomized clinical trial. JAMA 2017; 318 (11) 1026-1034
    CrossrefPubMedGoogle Scholar