Post-cesarean delivery infectious morbidity: Focus on preoperative antibiotics and methicillin-resistant Staphylococcus aureus.
BACKGROUND
Randomized controlled trials show that administering preoperative antibiotics prior to cesarean delivery (CD) significantly reduces the incidence of post-CD infectious morbidity. Methicillin-resistant Staphylococcus aureus (MRSA) has become prevalent in obstetrics and gynecology. The objective of this trial is to examine infectious morbidity in a clinical setting before versus after implementation of a preoperative antibiotic policy and, further, to describe the organisms cultured from CD wound infections.


METHODS
We used a retrospective chart review of women delivering by CD before and after implementation of preoperative antibiotic policy.


RESULTS
Prior to instituting the preoperative antibiotic policy, the incidence of post-CD infectious morbidity was 20.7% and dropped to 8.5% after the policy was established (P < .001). Study cohorts were similar (P > .05) in several risk factors for infection. MRSA was the most common organism isolated from post-CD wound infections (18/34, 53%). Endomyometritis accounted for the majority of post-CD infections (143/191, 74.9%), and most infections occurred within 7 days of CD (170/191, 89.0%).


CONCLUSIONS
The incidence of post-CD infectious complications decreased after a policy of administering preoperative antibiotics was instituted. MRSA was the most common organism isolated from post-CD wound infections. Further studies into the benefit of MRSA coverage in CD preoperative antibiotic regimens are needed.
Thurman
Andrea Ries
AR
Department of Obstetrics and Gynecology, Eastern Virginia Medical School, CONRAD Clinical Research Center, Norfolk, VA 23507, USA. thurmaar@evms.edu
Anca
Yadira
Y
White
Cassandra A
CA
Soper
David E
DE
D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D002511:Cephalosporins / Q000008:administration & dosage / Q000627:therapeutic use; D002585:Cesarean Section; D015331:Cohort Studies; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D015994:Incidence; D017053:Infection Control; D016106:Methicillin Resistance; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D011183:Postoperative Complications / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D011247:Pregnancy; D011300:Preoperative Care; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D013781:Texas / Q000453:epidemiology; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D002511:Cephalosporins