title: Predictors of antibiotic prophylactic failure in post-cesarean endometritis.
abstract: Despite the use of prophylactic antibiotics, endometritis occurs in 1-31% of patients after cesarean delivery. We sought to identify predictors of prophylactic antibiotic failure. In a retrospective review of 1800 cesarean deliveries, 766 patients had either ampicillin or cefazolin prophylaxis; 240 (31.3%) developed endometritis. Stepwise logistic regression identified the number of vaginal examinations (P less than .001), nulliparity (P = .001), low gestational age (P = .033), and cefazolin use (P = .002) as predictors of endometritis. One in two women with six or more vaginal examinations before cesarean delivery will have prophylactic failure. In preterm gestations (N = 177), the number of vaginal examinations was the single predictor of prophylactic antibiotic failure (P = .002). The number of vaginal examinations can be used to design new strategies to prevent a high rate of prophylactic failure.
authors.affiliation: Department of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio.
authors.forename: P L
authors.initials: PL
authors.lastname: Chang
authors.forename: E R
authors.initials: ER
authors.lastname: Newton
mesh_terms: D000667:Ampicillin / Q000627:therapeutic use*; D002437:Cefazolin / Q000627:therapeutic use*; D002585:Cesarean Section; D004716:Endometritis / Q000382:microbiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D016017:Odds Ratio; D011183:Postoperative Complications / Q000382:microbiology / Q000517:prevention & control*; D011897:Random Allocation; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000667:Ampicillin; D002437:Cefazolin