The rate of obesity among US women has been increasing, and obesity is associated with increased risk of surgical site infection (SSI) following cesarean delivery. The optimal perioperative antibiotic prophylactic regimen in this high-risk population undergoing cesarean delivery is unknown. OBJECTIVE To determine rates of SSI among obese women who receive prophylactic oral cephalexin and metronidazole vs placebo for 48 hours following cesarean delivery. DESIGN, SETTING, AND PARTICIPANTS Randomized, double-blind clinical trial comparing oral cephalexin and metronidazole vs placebo for 48 hours following cesarean delivery for the prevention of SSI in obese women (prepregnancy BMI Ն30) who had received standard intravenous preoperative cephalosporin prophylaxis. Randomization was stratified by intact vs rupture of membranes prior to delivery. The study was conducted at the

No abstract

(JAMA 2017;318(11):1026–1034) Previous studies estimated 3% to 12% of all cesarean deliveries in the United States are complicated by surgical site infection (SSI). This risk increases as maternal weight increases, and despite preoperative antibiotic regimens, obesity is an independent risk factor for SSI. While standard care has been the use of preoperative cephalosporin antibiotics, other antibiotic combinations have been studied. However, conflicting benefits have been found and none of these studies focused specifically on obese women. In this study, the effects of an additional 48-hour course of postoperative prophylactic oral cephalexin plus metronidazole was compared with the current standard of care (preoperative intravenous cephalosporin alone) in obese women who delivered via cesarean section.

(Abstracted from JAMA 2017;318(11):1026–1034) Surgical site infection (SSI) is a major complication of cesarean delivery, and the risk of SSI increases with obesity despite recommended preoperative antibiotic regimens. This randomized clinical trial aimed to compare the efficacy of postoperative, prophylactic oral cephalexin plus metronidazole with standard preoperative intravenous cephalosporin alone on SSI among obese women after cesarean delivery.