title: Post-cesarean delivery infectious morbidity: Focus on preoperative antibiotics and methicillin-resistant Staphylococcus aureus.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynecology, Eastern Virginia Medical School, CONRAD Clinical Research Center, Norfolk, VA 23507, USA. thurmaar@evms.edu
authors.forename: Andrea Ries
authors.initials: AR
authors.lastname: Thurman
authors.forename: Yadira
authors.initials: Y
authors.lastname: Anca
authors.forename: Cassandra A
authors.initials: CA
authors.lastname: White
authors.forename: David E
authors.initials: DE
authors.lastname: Soper
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins