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Operative Obstetrics

Poster Session 4

(970) The effectiveness of a CD bundle with vaginal preparation, Cefazolin and Azithromycin in reducing infections

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Recent data suggest that vaginal preparation and adjunctive macrolide administration reduce the risk of infectious morbidity in non-elective cesarean deliveries (CD).  We aimed to evaluate the effectiveness of a CD bundle including preoperative vaginal preparation, Cefazolin and Azithromycin administration, as compared to Cefazoline alone, in reducing post-operative infections in CD performed in the second stage of labor.

Study Design:

As of August 2016, our departmental treatment protocol for prevention of infectious morbidity in second stage CD has been replaced from preoperatively IV 2g Cefazolin alone, to preoperatively IV 2g Cefazolin, IV 500 mg Azithromycin and vaginal preparation (vaginal wash with povidone-iodine).  The medical records of all women who underwent CD during the second stage of labor were reviewed, comparing two time periods: 01.2014-08.2016 (control group, Cefazoline alone) and 11.2016-1.2021 (CD bundle group). Obstetric characteristics, post-op infections and neonatal outcomes were compared between the groups.  Composite infectious morbidity was defined as the occurrence of one or more of the following: endometritis, surgical site infection (SSI), abscess, urinary tract infection and post-partum fever.

Results:

The CD bundle group (n=331) group had lower rates of endometritis, SSI, and composite infectious morbidity compared to the control group (1.2% vs 4.8%, p=0.03; 3.0% vs 7.1%, p=0.049, 6.9% vs 14.3%, p=0.014, respectively).  Neonatal outcomes did not differ between groups. Multivariable regression analysis adjusted for confounders revealed that the CD bundle reduced the risk for the composite infection outcome, with an adjusted OR of 0.30, (95% CI 0.09-0.92).

Conclusion: In second stage CD, the addition of preoperative Azithromycin and vaginal preparation to Cefazolin, is efficacious in reducing post-operative infections.