title: Risk factors for post-operative wound infection in the setting of chorioamnionitis and cesarean delivery.
abstract: OBJECTIVE
  The objective of this study was to identify factors associated with an increased risk of post-operative wound infection in women with chorioamnionitis who undergo cesarean delivery.
  
  
  METHODS
  We conducted a retrospective cohort study of women with clinical chorioamnionitis who underwent cesarean delivery at a tertiary-care center between June 2010 and May 2013. Demographic data, labor and delivery details and post-operative outcomes were collected. Women with and without post-operative wound infections were compared.
  
  
  RESULTS
  Of 213 women with clinical chorioamnionitis who underwent cesarean delivery, 32 (15%) developed wound infections. Women with wound infection were more likely to have a body mass index (BMI) greater than or equal to 40 (p = 0.04), chronic hypertension (p = 0.03), leukocytosis on presentation (p = 0.046) or use tobacco (p = 0.002). Women who received ertapenem postpartum were less likely to develop wound infection than those who did not receive antibiotics (p = 0.02) or those that received ampicillin, gentamicin and clindamycin (p = 0.005).
  
  
  CONCLUSIONS
  Elevated BMI, tobacco use, chronic hypertension and leukocytosis at admission were associated with an increased risk of wound infection. Ertapenem appeared to reduce the risk of post-operative wound infections in women who had chorioamnionitis and underwent cesarean delivery. This could be considered as a treatment option for this high-risk population.
authors.affiliation: a Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology , University of North Carolina , Chapel Hill , NC , USA .
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Dotters-Katz
authors.affiliation: b Duke University Medical School, Duke University , Durham , NC , USA .
authors.forename: Chelsea
authors.initials: C
authors.lastname: Feldman
authors.affiliation: c Department of Obstetrics and Gynecology , Duke University , Durham , NC , USA , and.
authors.forename: Allison
authors.initials: A
authors.lastname: Puechl
authors.affiliation: d Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology , Duke University , Durham , NC , USA.
authors.forename: Chad A
authors.initials: CA
authors.lastname: Grotegut
authors.affiliation: d Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology , Duke University , Durham , NC , USA.
authors.forename: R Phillips
authors.initials: RP
authors.lastname: Heine
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D002821:Chorioamnionitis; D005260:Female; D006801:Humans; D009657:North Carolina / Q000453:epidemiology; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult
keywords: Cesarean delivery; chorioamnionitis; ertapenem; wound infection