Single dose cefazolin prophylaxis for postcesarean infections: Before vs. after cord clamping

Wax, Joseph R.; Hersey, Kelly; Philput, Christine; Wright, Mark S.; Nichols, Katharine V.; Eggleston, Maurice K.; Smith, James F.

doi:10.1002/(sici)1520-6661(199701/02)6:1<61::aid-mfm13>3.0.co;2-p

Cited by 28 publications

(23 citation statements)

References 8 publications

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“…Some authors argue that the most effective regimen has not been established yet [10]. For example single dose cephalosporins have been widely used for antimicrobial prophylaxis during cesarean delivery [11-13]. However in one study it was shown that a broader combination of cefazolin and metronidazole provided better efficacy with regards to post-operative infectious diseases morbidity and duration of hospitalization when compared with cefazolin alone [10].…”

Section: Introductionmentioning

confidence: 99%

Ampicillin/Sulbactam versus Cefuroxime as antimicrobial prophylaxis for cesarean delivery: a randomized study

et al. 2010

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BackgroundThe efficacy and safety of a single dose of ampicillin/sulbactam compared to a single dose of cefuroxime at cord clamp for prevention of post-cesarean infectious morbidity has not been assessed.MethodsWomen scheduled for cesarean delivery were randomized to receive a single dose of either 3 g of ampicillin-sulbactam or 1.5 g of cefuroxime intravenously, after umbilical cord clamping. An evaluation for development of postoperative infections and risk factor analysis was performed.ResultsOne hundred and seventy-six patients (median age 28 yrs, IQR: 24-32) were enrolled in the study during the period July 2004 - July 2005. Eighty-five (48.3%) received cefuroxime prophylaxis and 91 (51.7%) ampicillin/sulbactam. Postoperative infection developed in 5 of 86 (5.9%) patients that received cefuroxime compared to 8 of 91 (8.8%) patients that received ampicillin/sulbactam (p = 0.6). In univariate analyses 6 or more vaginal examinations prior to the operation (p = 0.004), membrane rupture for more than 6 hours (p = 0.08) and blood loss greater than 500 ml (p = 0.018) were associated with developing a postoperative surgical site infection (SSI). In logistic regression having 6 or more vaginal examinations was the most significant risk factor for a postoperative SSI (OR 6.8, 95% CI: 1.4-33.4, p = 0.019). Regular prenatal follow-up was associated with a protective effect (OR 0.04, 95% CI: 0.005-0.36, p = 0.004).ConclusionsAmpicillin/sulbactam was as safe and effective as cefuroxime when administered for the prevention of infections following cesarean delivery.Trial registrationClinicaltrials.gov identifier: NCT01138852

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Section: Introductionmentioning

confidence: 99%

Ampicillin/Sulbactam versus Cefuroxime as antimicrobial prophylaxis for cesarean delivery: a randomized study

et al. 2010

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“…The debate on the timing of antibiotic administration at cesarean has emerged in the last several years with the publication of several observational studies, 6,9,11 clinical trials, 5,7,8,10,[12][13][14]18 a review article, 19 and meta-analyses. 16,20 These results culminated in American College of Obstetricians Gynecologists issuing a Committee Opinion advocating that all women undergoing a cesarean delivery be given prophylactic antibiotics before skin incision, 17 and the National Institute for Health and Clinical Excellence advising clinicians to offer prophylactic antibiotics at cesarean before skin incision.…”

Section: Discussionmentioning

confidence: 99%

“…5 Several studies since have been published on the timing of prophylactic antibiotic administration for cesarean delivery, but they had mixed results and many of the studies were underpowered. [5][6][7][8][9][10][11][12][13][14] Therefore, the question of the importance of antibiotic timing in cesarean section still remains. Our study evaluates the timing of antibiotic administration in a large community hospital setting.…”

Section: Introductionmentioning

confidence: 99%

Timing of prophylactic antibiotic at cesarean section: a double-blinded, randomized trial

et al. 2013

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OBJECTIVE:The purpose was to determine the effect of the timing of prophylactic antibiotics for cesarean section on post-operative infectious complications. STUDY DESIGN: This was a prospective, double-blinded, randomized controlled trial in which patients were randomized to receive cefazolin or clindamycin either before skin incision or after cord clamp. The primary outcome was maternal infectious morbidity at 6 weeks postpartum, a composite infectious outcome, which included endometritis, urinary tract infection, wound infection and pneumonia. RESULT: Data on 896 women were analyzed; 449 randomized to skin incision, 447 to cord clamp. Postpartum infections were seen in a total of 8.4% of patients. Timing of antibiotic administration did not significantly affect any maternal postpartum infection rates or selected neonatal outcomes. CONCLUSION: Our results suggest that, in a largely non-laboring population, the timing of prophylactic antibiotic administration does not impact post-operative infectious complications of the mother. Despite being one of the largest randomized controlled trials to address this question, our study still lacked sufficient power to make definitive conclusions.

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“…When to Give the Antibiotics Compared with after cord clamp, administration of antibiotics within 1 hour before skin incision is associated with a lower incidence of endometritis and wound infection (14)(15)(16)(17)(18)(19).…”

Section: Quality Of Evidencementioning

confidence: 97%

Cesarean delivery

Berghella¹

2012

Obstetric Evidence Based Guidelines

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Single dose cefazolin prophylaxis for postcesarean infections: Before vs. after cord clamping

Cited by 28 publications

References 8 publications

Ampicillin/Sulbactam versus Cefuroxime as antimicrobial prophylaxis for cesarean delivery: a randomized study

Ampicillin/Sulbactam versus Cefuroxime as antimicrobial prophylaxis for cesarean delivery: a randomized study

Timing of prophylactic antibiotic at cesarean section: a double-blinded, randomized trial

Cesarean delivery

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