Infectious Diseases
Poster Session 4
Taylor S. Freret, MD
Massachusetts General Hospital
Cambridge, MA, United States
Kaitlyn E. James, PhD, MPH (she/her/hers)
Massachusetts General Hospital
Boston, MA, United States
.jpg "Mark A. Clapp, MD, MPH (he/him/his) photo")
Mark A. Clapp, MD, MPH (he/him/his)
Massachusetts General Hospital
Boston, MA, United States
Anjali J. Kaimal, MD (she/her/hers)
Professor and Vice Chair of Clinical Operations, Department of OBGYN
University of South Florida Morsani College of Medicine
Tampa, FL, United States
Malavika Prabhu, MD (she/her/hers)
Assistant Professor, Division of Maternal Fetal Medicine
Massachusetts General Hospital
Boston, MA, United States
Patients with intraamniotic infection (IAI) are at increased risk of postpartum infection. For patients with IAI receiving broad-spectrum antibiotics and undergoing cesarean delivery (CD), the optimal surgical antibiotic prophylaxis is unknown. We sought to determine if preoperative cefazolin in patients with IAI is associated with reduced postpartum infection.
Study Design:
Retrospective cohort study of patients with IAI (from ICD10 codes) undergoing unscheduled CD for a ≥24-week singleton between 2017-2022 within one healthcare system. Exclusion criteria were PPROM. The primary exposure was cefazolin administration at delivery; antibiotics received before or on the day of delivery were obtained from the medical record. The primary outcome was a composite of infection within 6 weeks postpartum (ICD10 codes for endometritis, SSI, sepsis, or postoperative infection; or post-delivery positive blood, wound, respiratory, or urinary cultures). Secondary outcomes included incisional complications (cellulitis, disruption, or positive wound culture) and need for oral antibiotics after delivery. Multivariable logistic regression analysis controlled for delivery BMI, smoking, pregestational diabetes, failure to progress CD indication, duration of membrane rupture (hours), and use of adjunctive azithromycin.
Results:
During the study, 1,306 patients with IAI delivered. Predelivery antibiotic regimens received varied widely; most included ampicillin and gentamicin (70.5%). Cefazolin was administered to 1,040 (79.6%) of patients. The primary outcome occurred in 227 (17.4%) patients; 51 (3.9%) had an incisional complication and 156 (11.9%) received oral antibiotics after delivery. In the adjusted model, receipt of cefazolin was associated with lower odds of the primary outcome (aOR 0.80, 95% CI 0.69-0.93, p< 0.01), incisional complications (aOR 0.48, 95% CI 0.30-0.76, p< 0.01), and post-delivery oral antibiotic use (aOR 0.82, 95% CI 0.74-0.90, p< 0.01) (Table).
Conclusion:
Cefazolin surgical prophylaxis for patients with IAI undergoing CD is associated with a reduction in postoperative infection.