title: Effect of a change in policy regarding the timing of prophylactic antibiotics on the rate of postcesarean delivery surgical-site infections.
abstract: OBJECTIVE
  The purpose of this study was to examine the effect of a change in policy regarding the timing of antibiotic administration on the rates of postcesarean delivery surgical-site infections (SSI).
  
  
  METHODS
  This was a retrospective cohort study of 1316 term, singleton cesarean deliveries at 1 institution. A policy change was instituted wherein prophylactic antibiotics were given before skin incision rather than after cord clamp. The primary outcome that was examined was SSI; secondary outcomes were the rates of endometritis and cellulitis. Multivariable regression was performed to control for potential confounders.
  
  
  RESULTS
  The overall rate of SSI fell from 6.4-2.5% (P = .002). When we controlled for potential confounders, there was a decline in overall SSI with an adjusted odds ratio (aOR) of 0.33 (95% CI, 0.14,0.76), a decrease in endometritis (aOR, 0.34; 95% CI, 0.13,0.92), and a trend towards a decrease in cellulitis (aOR, 0.22; 95% CI, 0.05,1.22).
  
  
  CONCLUSIONS
  At our institution, a change in policy to administer prophylactic antibiotics before skin incision led to a significant decline in postcesarean delivery SSIs.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA. kaimala@obgyn.ucsf.edu
authors.forename: Anjali J
authors.initials: AJ
authors.lastname: Kaimal
authors.forename: Marya G
authors.initials: MG
authors.lastname: Zlatnik
authors.forename: Yvonne W
authors.initials: YW
authors.lastname: Cheng
authors.forename: Mari-Paule
authors.initials: MP
authors.lastname: Thiet
authors.forename: Elspeth
authors.initials: E
authors.lastname: Connatty
authors.forename: Patricia
authors.initials: P
authors.lastname: Creedy
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Caughey
mesh_terms: D019072:Antibiotic Prophylaxis / Q000379:methods* / Q000639:trends; D002481:Cellulitis / Q000453:epidemiology / Q000517:prevention & control; D002585:Cesarean Section; D002985:Clinical Protocols; D004716:Endometritis / Q000453:epidemiology / Q000517:prevention & control; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D016015:Logistic Models; D009775:Obstetrics and Gynecology Department, Hospital / Q000458:organization & administration; D016017:Odds Ratio; D011247:Pregnancy; D011300:Preoperative Care; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*