Does Adjunctive Azithromycin Treatment at the Time of Cesarean Delivery Improve Maternal and Neonatal Outcomes [32I]

Abstract

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.