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Infectious Diseases

Poster Session 4

(1009) Surgical site infection severity in patients receiving non-cephalosporin antibiotics at time of cesarean section

Wednesday, February 14, 2024

1:00 PM – 2:30 PM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Clara Grayhack, MD

Resident Physician
West Penn Hospital- Allegheny Health Network
Pittsburgh, PA, United States

Coauthor(s)

MA

Mary Angelides, MD

West Penn Hospital- Allegheny Health Network
Pittsburgh, PA, United States
Kristin C. Darwin, MD (she/her/hers)

Fellow
Johns Hopkins University School of Medicine
Baltimore, MD, United States
MB

Marie Bielman, BS

Johns Hopkins University School of Medicine
Baltimore, MD, United States
DR

Devon Ramaeker, MD

Allegheny Health Network
Pittsburgh, PA, United States
Michael M. Aziz, MD, MPH (he/him/his)

Physician
Allegheny Health Network
Pittsburgh, PA, United States
JK

Jaden Kohn, MD, MPH

Johns Hopkins University School of Medicine
Baltimore, MD, United States
JS

Jeanne Sheffeild, MD

Johns Hopkins University School of Medicine
Baltimore, MD, United States
Arthur J. Vaught, MD

Johns Hopkins University School of Medicine
Baltimore, MD, United States

Objective: To determine severity of surgical site infections (SSI) occurring in patients receiving cephalosporin versus non-cephalosporin based prophylaxis at time of cesarean section (CS)

Study Design: This is a retrospective chart review of all SSIs occurring at two tertiary care centers. Inclusion criteria included women who had CS from 1/1/2016 to 12/31/2022. Exclusion criteria included combined delivery of multiples. Our primary outcome was development of organ space SSI. Secondary outcomes included postpartum endometritis, incisional infection, postpartum readmission, and other indicators of maternal morbidity data was analyzed using standard statistical tests.

Results: We identified 134 patients with SSI: 112 received a standard (cephalosporin-based) regimen and 22 received a non-standard (non-cephalosporin-based regimen). Cohorts were similar in demographics and medical co-morbidities (Table). Those in non-standard cohort were more likely to develop an organ/space SSI (p = 0.04) and require hospital readmission (p = 0.05). There were also higher rates of composite procedures (return to OR, hysterectomy, drain placement) in the non-standard group, but did not reach significance. 59% (n=13) of patients in the non-standard group went on to receive a penicillin analogue for subsequent treatment without allergic reaction.

Conclusion: Patients with SSI who received non-standard (non-cephalosporin antibiotics) regimens at CS were more likely to develop organ/space SSI and experience hospital readmission. Further, the majority of the non-standard cohort subsequently received penicillin analogues noting the importance of allergy testing in reducing SSI related morbidity and associated resource utilization.