Administration of cefazolin prior to skin incision is superior to cefazolin at cord clamping in preventing postcesarean infectious morbidity: a randomized, controlled trial.
OBJECTIVE
The objective of the study was to determine whether the administration of cefazolin prior to skin incision was superior to administration at the time of umbilical cord clamping for the prevention of postcesarean infectious morbidity.


METHODS
This was a prospective, randomized, double-blind, placebo-controlled trial. Study subjects received cefazolin 15-60 minutes prior to incision and controls received cefazolin at the time of cord clamping. The occurrence of endomyometritis, wound infection, total infectious morbidity, and neonatal complications were compared.


RESULTS
There were 357 subjects enrolled. No demographic differences were observed between groups. There were decreased total infectious morbidity in the study group (relative risk [RR] = 0.4, 95% confidence interval [CI] 0.18 to 0.87), decreased endometritis (RR = 0.2, 95% CI 0.15 to 0.94). No increase in neonatal sepsis (P = .99), sepsis workups (P = .96), or length of stay (P = .17) was observed.


CONCLUSIONS
Administration of prophylactic cefazolin prior to skin incision resulted in a decrease in both endomyometritis and total postcesarean infectious morbidity, compared with administration at the time of cord clamping. This dosing did not result in increased neonatal septic workups or complications.
Sullivan
Scott A
SA
Department of Obstetrics/Gynecology, Medical University of South Carolina, Charleston, SC 29425, USA. sullivas@musc.edu
Smith
Triz
T
Chang
Eugene
E
Hulsey
Thomas
T
Vandorsten
J Peter
JP
Soper
David
D
D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000517:prevention & control*; D002437:Cefazolin / Q000008:administration & dosage*; D002585:Cesarean Section; D003250:Constriction; D004311:Double-Blind Method; D004716:Endometritis / Q000517:prevention & control; D005260:Female; D006801:Humans; D011183:Postoperative Complications; D011247:Pregnancy; D011446:Prospective Studies; D018805:Sepsis / Q000517:prevention & control; D013530:Surgical Wound Infection / Q000517:prevention & control; D013997:Time Factors; D014470:Umbilical Cord / Q000601:surgery
D000900:Anti-Bacterial Agents; D002437:Cefazolin