OBJECTIVE: To estimate the efficacy of antibiotic prophylaxis at the time of nonlaboring cesarean delivery in reducing postpartum infection-related complications.
METHODS: We performed a secondary analysis of an observational study of cesarean deliveries performed at 13 centers from 1999–2000. Patients were included if they had cesarean delivery before labor, did not have intrapartum infection, and were not given antibiotics at delivery for reasons other than prophylaxis. The occurrence of postpartum endometritis, wound infection, and other, less common infection-related complications was compared between those who did and did not receive antibiotic prophylaxis. Results were adjusted for smoking, payer status, gestational age and body mass index at delivery, race, diabetes, antepartum infections, presence of anemia, operative time, type of cesarean delivery (primary or repeat), and center.
RESULTS: Of the 9,432 women who met study criteria, the 6,006 (64%) who received antibiotic prophylaxis were younger, heavier at delivery, and were more likely to be African American, receive public insurance, and have diabetes. Patients who received antibiotic prophylaxis were less likely to develop postpartum endometritis (121 [2.0%] compared with 88 [2.6%], adjusted odds ratio [OR] 0.40, 95% confidence interval [CI] 0.28–0.59) or wound infection (31 [0.52%] compared with 33 [0.96%], adjusted OR 0.49, 95% CI 0.28–0.86).
CONCLUSION: Antibiotic prophylaxis at the time of nonlaboring cesarean delivery significantly reduces the risks of postpartum endometritis and wound infection.
LEVEL OF EVIDENCE: III
Antibiotic prophylaxis at the time of nonlaboring cesarean delivery significantly reduces the risks of postpartum endometritis and wound infection.
From the Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois; the Ohio State University, Columbus, Ohio, the University of Alabama at Birmingham, Birmingham, Alabama; the University of Utah, Salt Lake City, Utah; the University of Pittsburgh, Pittsburgh, Pennsylvania; Thomas Jefferson University, Philadelphia, Pennsylvania; Wayne State University, Detroit, Michigan; the University of Cincinnati, Cincinnati, Ohio; the University of Miami, Miami, Florida; the University of Tennessee, Memphis, Tennessee; the University of Texas at San Antonio, San Antonio, Texas; the George Washington University Biostatistics Center, Washington, DC; and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.
*For a list of other members of the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Maryland, see the Appendix online at http://links.lww.com/AOG/A126.
Supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (HD21410, HD21414, HD27860, HD27861, HD27869, HD27905, HD27915, HD27917, HD34116, HD34122, HD34136, HD34208, HD34210, and HD36801).
The authors thank Francee Johnson, BSN, and Julia Gold, RN, for protocol development and coordination between clinical research centers, and Elizabeth Thom, PhD, for protocol/data management and statistical analysis.
Presented in poster format at the 54th Annual Meeting of the Society for Gynecologic Investigation, Reno, Nevada; March 15–17, 2007.
Corresponding author: Mara J. Dinsmoor, MD, MPH, Department of Obstetrics and Gynecology, Feinberg School of Medicine of Northwestern University, NorthShore University HealthSystem, 2650 Ridge Avenue, Walgreen Building, Suite 1507, Evanston, IL 60201; e-mail: firstname.lastname@example.org.
Financial Disclosure The authors did not report any potential conflicts of interest.