Efficacy of Non-Beta-lactam Antibiotics for Prevention of Cesarean Delivery Surgical Site Infections

Abstract

Objective To examine the association between perioperative Beta (β))-lactam versus non-β-lactam antibiotics and cesarean delivery surgical site infection (SSI). Study Design Retrospective cohort of women undergoing cesarean delivery from January 1 to December 31, 2014. All women undergoing cesarean after 34 weeks with a postpartum visit were included. Prevalence of SSI was compared between women receiving β-lactam versus non-β-lactam antibiotics. Bivariate analyses were performed using Pearson's Chi-square, Fisher's exact, or Wilcoxon's rank-sum tests. Logistic regression models were fit controlling for possible confounders. Results Of the 929 women included, 826 (89%) received β-lactam prophylaxis and 103 (11%) received a non-β-lactam. Among the 893 women who reported a non-type I (low risk) allergy, 819 (92%) received β-lactam prophylaxis. SSI occurred in 7% of women who received β-lactam antibiotics versus 15% of women who received a non-β-lactam (p = 0.004). β-Lactam prophylaxis was associated with lower odds of SSI compared with non-β-lactam antibiotics (odds ratio [OR] = 0.43; 95% confidence interval [CI] = 0.22–0.83; p = 0.01) after controlling for chorioamnionitis in labor, postlabor cesarean, endometritis, tobacco use, and body mass index (BMI). Conclusion β-Lactam perioperative prophylaxis is associated with lower odds of a cesarean delivery surgical site infection compared with non-β-lactam antibiotics.

Preoperative cefazolin rather than clindamycin or metronidazole is associated with lower postpartum infection among women with chorioamnionitis delivering by cesarean delivery

“…This association was likely due to fewer surgical site infections with cefazolin, which is concordant with 2 recent studies conducted at a single academic institution and using the same MFMU dataset as the current study, showing the protective effect of cefazolin more generally for surgical site infection among women delivering by cesarean delivery who did not have chorioamniontis. 19,20 A similar association with cefazolin has also been noted with regard to surgical site infection after hysterectomy.21 The decreased risk of surgical site infection with cefazolin may be due to its efficacy against skin flora, including Streptococcus species, Staphylococcus aureus, and coagulase-negative Staphylococcus. 37,38 In the current study, the observed finding was despite the fact that women treated with cefazolin were less likely to receive postpartum antibiotics compared to those treated with clindamycin or gentamicin.…”

Documented β-Lactam Allergy and Risk for Cesarean Surgical Site Infection

“…Literature shows that administration of non- β -lactam prophylaxis increases the risk of adverse surgical outcomes including SSI [ 1 – 3 , 18 , 41 ]. Hopkins et al and Harris et al separately retrospectively analyzed the prevalence of CD SSI between women who received perioperative β -lactam vs. non- β -lactam prophylaxis [ 1 , 2 ]. Both studies showed that patients who received non- β -lactam antibiotics were more likely to have a wound complication, including infection, versus those who received β -lactam antibiotics (14.6% vs. 6.7% by Hopkins et al and 15% vs. 7% by Harris et al) [ 1 , 2 ].…”

“…Hopkins et al and Harris et al separately retrospectively analyzed the prevalence of CD SSI between women who received perioperative β -lactam vs. non- β -lactam prophylaxis [ 1 , 2 ]. Both studies showed that patients who received non- β -lactam antibiotics were more likely to have a wound complication, including infection, versus those who received β -lactam antibiotics (14.6% vs. 6.7% by Hopkins et al and 15% vs. 7% by Harris et al) [ 1 , 2 ]. Thus, these studies identified an increased odd of SSI with non- β -lactam prophylaxis consistent with our findings (aOR = 1.43; 95%CI = 1.01–2.02; p = 0.045) [ 1 , 2 ].…”

“…Both studies showed that patients who received non- β -lactam antibiotics were more likely to have a wound complication, including infection, versus those who received β -lactam antibiotics (14.6% vs. 6.7% by Hopkins et al and 15% vs. 7% by Harris et al) [ 1 , 2 ]. Thus, these studies identified an increased odd of SSI with non- β -lactam prophylaxis consistent with our findings (aOR = 1.43; 95%CI = 1.01–2.02; p = 0.045) [ 1 , 2 ]. However, our study is novel in that it explicitly evaluated the relationships between SSI and β -lactam allergy in addition to the type of prophylaxis given.…”

Time Has Come for Routine Penicillin Allergy Testing in Obstetrics

“…In women who report a penicillin allergy, the inability to utilize a β-lactam antibiotic during pregnancy has been associated with less effective intrapartum neonatal group B streptococcus (GBS) prophylaxis, a greater rate of cesarean surgical site infection and increased risk of postpartum endometritis. [4][5][6] However, when penicillin allergy testing is performed in individuals who report a history of a penicillin allergy, the majority do not exhibit a positive reaction. 7 Despite penicillin allergy testing being shown to be safe during pregnancy, it is rarely performed.…”