INTRODUCTION: Postpartum (PP) infections are more common after Cesarean section (CS) compared to vaginal deliveries. Preoperative Cefazolin is commonly used, recent evidence indicates that adding azithromycin (AZI) as extended antibiotic coverage decreases the risk of infectious comorbidities for non-elective CS (nCS). Since 2017, our L&D used AZI + cefazolin in nCS. Goal was to determine if adding preoperative AZI lowers PP infections. METHODS: An IRB approved retrospective cohort study conducted. ST antibiotics (1st generation cephalosporin or clindamycin and gentamycin with allergy). Women placed in 2 groups: ST+AZI versus ST. Exclusion criteria: elective CD, no preoperative antibiotics, AZI allergy. The primary outcome: composite of maternal wound infection, endomyometritis, maternal morbidity, neonatal intensive care unit (NICU) admission, respiratory distress syndrome, neonatal morbidity. Statistical analyses performed with p value <0.05 significant. RESULTS: 100 women in study, 28 in the ST+AZI group and 72 in ST group. Women were more likely to be younger (29.2 vs 31.3 years, p 0.04), have rupture of membranes (78.6% vs 50%, p 0.03) in ST+AZI versus ST. The demographics, indication for delivery, gestational age at delivery, type of skin incision, closure, preparation were similar. There was no difference in the composite outcome between the ST and ST + AZI group (5.6% vs 10.6%, RR 1.3 [CI 0.7-2.5] p 0.55); the rate of NICU admission was nearly statistically significantly higher in ST group versus ST+AZI (36% vs 14.2%, RR 0.8 [CI 0.6-0.9] p value 0.05). CONCLUSION: Adjunctive AZI at time of CD does not appear to improve maternal and neonatal outcomes in our population.

5571 Background: Racial disparities in uterine cancer outcomes are present, as Black patients with uterine cancer have markedly higher mortality when compared with White patients. Potential etiologies of this discrepancy have been investigated, including implicit bias, histopathologic factors and stage at presentation, molecular and genetic factors, and socioeconomic factors. The purpose of this study is to explore if non-White patients with uterine cancer are more likely to experience distant cancer recurrence compared to White patients. Methods: A single-institution retrospective cohort study was performed examining all patients diagnosed with uterine cancer from 2006-2016. Data regarding patient demographics, medical co-morbidities, histology, stage, treatment course, and disease recurrence were abstracted from the medical record. Race was categorized based on how a patient was registered in the medical record. The primary outcome was location of recurrence, with local recurrence defined as vaginal/cuff recurrence and distant recurrence representing nodal, intraperitoneal, or distant recurrence. A multivariable regression model was built in a backwards stepwise fashion to examine the association of individual covariates with distant recurrence as opposed to vaginal recurrence. Results: A total of 1205 patients with uterine cancer were included for analysis. Three hundred eighteen (26.5%) patients were White, 472 (39.2%) Black, 319 (26.5%) Hispanic, 91 (7.6%) Asian, and 4 (0.3%) other. A total of 223 (18.5%) patients experienced disease recurrence. Black women experienced a statistically significant increased risk of recurrence compared with non-Black women [OR 1.99 (95% CI 1.37-2.88), p < 0.01]. Additionally, Black patients were significantly more likely to experience nodal, intra-peritoneal and distant recurrences relative to White patients (p < 0.01). When adjusting for covariates including race, histology, grade, stage and adjuvant treatment, non-White race [OR 3.87 (95% CI (1.42-10.54), p < 0.01] was associated with significant increase in risk of distal recurrence. Conclusions: The findings of this study suggest that non-White race is potentially contributory to distant recurrence of uterine cancer, even when accounting for histopathologic differences, stage at presentation, and other traditional covariates. These findings suggest that the disparate outcomes experienced by non-White patients are likely multi-factorial in nature and highlight the need for efforts focused on optimizing treatment and improving outcomes of non-White women with uterine cancer.[Table: see text]

INTRODUCTION: The goal of preoperative antibiotics is to decrease and prevent postpartum infections. Recent evidence indicates that adding azithromycin (AZI) to Cefazolin as extended antibiotic coverage can decrease the risk of infectious co-morbidities for non-elective Cesarean Deliveries (nCD). November 2017 we started using AZI + cefazolin in nCD. The goal was to determine the institutional compliance to AZI administration. METHODS: An IRB approved retrospective cohort study over 4 months of patients undergoing nCD. ST (1st generation cephalosporin or, clindamycin and gentamycin for cephalosporin allergy). Patients in 2 groups: preEMR bundle (ST) and postEMR bundles (ST + AZI). Maternal and neonatal outcomes collected for 2 months preEMR bundle and 2 months postEMR bundles. Exclusion criteria: women undergoing elective CD, did not receive pre-operative antibiotics, AZI allergy. The primary outcome was overall compliance with AZI administration with the new EMR bundle. The composite outcome-maternal wound infection, endomyometritis, maternal morbidity, neonatal morbidity. Statistical analyses were performed with p value <0.05 significant. RESULTS: There were 100 patients meeting inclusion criteria in study time period. There were no differences in baseline demographics between groups. Only 56% of patients in the post EMR group received AZI in addition to ST. There were no significant differences in the composite outcome between groups. CONCLUSION: Adjunctive AZI at time of nCD does not appear to decrease the risk of maternal and neonatal outcomes; but it was only administered correctly in 56% of the eligible cases. The effect of AZI on outcomes may be improved with better adherence to the EMR bundle.

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