Perioperative antibiotic prophylaxis for nonlaboring cesarean delivery.
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).


CONCLUSIONS
Antibiotic prophylaxis at the time of nonlaboring cesarean delivery significantly reduces the risks of postpartum endometritis and wound infection.


METHODS
III.
Dinsmoor
Mara J
MJ
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.
Gilbert
Sharon
S
Landon
Mark B
MB
Rouse
Dwight J
DJ
Spong
Catherine Y
CY
Varner
Michael W
MW
Caritis
Steve N
SN
Wapner
Ronald J
RJ
Sorokin
Yoram
Y
Miodovnik
Menachem
M
O'Sullivan
Mary J
MJ
Sibai
Baha M
BM
Langer
Oded
O
D000328:Adult; D019072:Antibiotic Prophylaxis; D002585:Cesarean Section; D004715:Endometriosis / Q000517:prevention & control*; D005260:Female; D006801:Humans; D016017:Odds Ratio; D019990:Perioperative Care; D011247:Pregnancy; D011645:Puerperal Infection / Q000517:prevention & control*; D013530:Surgical Wound Infection / Q000517:prevention & control*; D055815:Young Adult