title: Antibiotic prophylaxis before surgery vs after cord clamping in elective cesarean delivery: a double-blind, prospective, randomized, placebo-controlled trial.
abstract: BACKGROUND
  Perioperative antibiotic prophylaxis during elective cesarean delivery at term to reduce postoperative maternal infectious morbidity is generally used but may not be effective on the basis of the available data. Also, the optimal timing of prophylactic antibiotic administration is unclear.
  
  
  OBJECTIVE
  To compare the effectiveness of cefazolin administered before skin incision vs cefazolin administered after umbilical cord clamping vs placebo in a 3-arm randomized trial. The primary objective of the study was to compare postoperative infectious morbidity, defined as wound infection, endometritis, or urinary tract infection (primary end point), in women with cefazolin vs placebo. The comparison between the 2 arms administering cefazolin before skin incision vs after umbilical cord clamping was a secondary end point.
  
  
  METHODS
  Double-blind, prospective, randomized, placebo-controlled trial.
  
  
  METHODS
  The Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria.
  
  
  METHODS
  We recruited 1112 women undergoing elective cesarean delivery at term from March 1, 2004, through January 31, 2010.
  
  
  METHODS
  In group 1, cefazolin (2 g) was administered 20 to 30 minutes before skin incision. In group 2, cefazolin (2 g) was administered immediately after clamping of the cord. In group 3, placebo was administered before skin incision.
  
  
  RESULTS
  The primary outcome was observed in 18 of 370 women in group 1 (4.9%) and in 14 of 371 women in group 2 (3.8%), whereas it was noted in 45 of 371 women in group 3 (12.1%) (P < .001 for group 1 plus group 2 vs group 3). The number needed to treat to avoid 1 primary outcome was 13 (95% CI, 9 to 24). Between groups 1 and 2, there was no statistically significant difference regarding postoperative infectious morbidity (P = .60).
  
  
  CONCLUSIONS
  We were able to demonstrate the usefulness in elective cesarean delivery of prophylactic cefazolin vs placebo in reducing postoperative maternal infectious morbidity.
authors.affiliation: Division of Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. armin.witt@meduniwien.ac.at
authors.forename: Armin
authors.initials: A
authors.lastname: Witt
authors.forename: Mehmet
authors.initials: M
authors.lastname: Döner
authors.forename: Ljubomir
authors.initials: L
authors.lastname: Petricevic
authors.forename: Angelika
authors.initials: A
authors.lastname: Berger
authors.forename: Peter
authors.initials: P
authors.lastname: Germann
authors.forename: Georg
authors.initials: G
authors.lastname: Heinze
authors.forename: Clemens
authors.initials: C
authors.lastname: Tempfer
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D001317:Austria; D002437:Cefazolin / Q000008:administration & dosage*; D002585:Cesarean Section / Q000379:methods*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004716:Endometritis / Q000517:prevention & control*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D061366:Numbers Needed To Treat; D019990:Perioperative Care; D011183:Postoperative Complications / Q000517:prevention & control*; D011247:Pregnancy; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control*; D014552:Urinary Tract Infections / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents; D002437:Cefazolin