Risk Factors for Postcesarean Maternal Infection in a Trial of Extended-Spectrum Antibiotic Prophylaxis: Correction

Abstract

Objective-To identify maternal clinical risk factors for postcesarean maternal infection in a randomized clinical trial of preincision extended-spectrum antibiotic prophylaxis.Methods-We conducted a planned secondary analysis of a randomized clinical trial. Patients were ≥ 24 weeks of gestation and delivered by cesarean delivery after a minimum of 4 hours of ruptured membranes or labor. All participants received standard preincision prophylaxis and were randomized to receive azithromycin or placebo. The primary outcome for this analysis is maternal infection: a composite outcome of endometritis, wound infection (superficial or deep), or other infections occurring up to 6 weeks postpartum. Maternal clinical characteristics associated with maternal infection, after controlling for azithromycin assignment, were identified. These maternal factors were included in a multivariable logistic regression model for maternal infection. HHS Public AccessResults-Of 2,013 patients, 1,019 were randomized to azithromycin. Overall, 177 (8.8%) had postcesarean maternal infection. In the final adjusted model, compared to the reference groups, women of Black race-ethnicity, with a nontransverse uterine incision, with duration of membrane rupture > 6 hours, and surgery duration > 49 minutes, were associated higher odds of maternal infection (all with adjusted odds ratios of ∼2); azithromycin was associated with lower odds of maternal infection (adjusted odds ratio of 0.4, 95% confidence interval 0.3-0.6.Conclusions-Despite preincision azithromycin-based extended spectrum antibiotic prophylaxis, postcesarean maternal infection remains a significant source of morbidity. Recognition of risk factors may help guide innovative prevention strategies.