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Am J Perinatol 2024; 41(S 01): e2645-e2650
DOI: 10.1055/a-2135-7084
Original Article

Standard-Dose Azithromycin in Class III Obese Patients Undergoing Unscheduled Cesarean Delivery

Maeve K. Hopkins 
1   Division of Maternal and Fetal Medicine, Obstetrics and Gynecology Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
,
Surabhi Tewari
2   Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
,
Meng Yao
3   Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
,
Lydia DeAngelo
2   Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
,
Lauren Buckley
4   Department of Obstetrics and Gynecology, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
,
Victoria Rogness
2   Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
,
Swapna Kollikonda
4   Department of Obstetrics and Gynecology, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
,
Oluwatosin Goje
5   Department of Obstetrics and Gynecology and Infectious Disease, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
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Abstract

Objective Perioperative antibiotic prophylaxis reduces cesarean wound complications. This study investigates whether integration of standard-dose (500 mg) azithromycin prophylaxis reduced wound complications in patients with class III obesity (body mass index [BMI] ≥ 40 kg/m2) undergoing unscheduled cesarean delivery.

Study Design Retrospective cohort study of patients with class III obesity undergoing unscheduled cesarean delivery in single hospital system from January 1, 2017, to January 1, 2020. A standard dose (500 mg) of azithromycin was integrated into system order sets in 2018. Medical history and postoperative wound outcomes were compared in pre- and postintegration cohorts. Wound complication was defined as composite of wound seroma, hematoma, superficial or deep infection.

Results A total of 1,273 patients met inclusion criteria, 303 patients in the preorder set group, and 970 patients in the postorder set group. Demographics were similar between the pre- and postintegration cohorts, including BMI (median: 44.4 kg/m2, p = 0.84) and weight at delivery (mean: 121.2 ± 17.8 kg, p = 0.57). Patients in the postintegration cohort had lower rates of composite postpartum wound complication (7.9 vs. 13.9%, p = 0.002), superficial infection or deep infection/abscess (6.7 vs. 10.2%, p = 0.042), and postpartum readmission or unscheduled visits (18.7 vs. 24.4%, p < 0.029). Rates of chorioamnionitis and endometritis were similar between the pre- and postintegration groups (8.6 vs. 6.9%, p = 0.33, and 1.7 vs. 1.9%, p = 0.81, respectively). Patients in the postintegration cohort had lower risk of postoperative composite wound complication (unadjusted odds ratio [OR]: 0.54, confidence interval [CI]: 0.36–0.80, p = 0.002) and lower rates of wound infection (unadjusted OR: 0.63, 95% CI: 0.40–0.99, p = 0.044). When comparing patients who received azithromycin at delivery and patients who did not, standard-dose azithromycin reduced risk of postoperative wound complication (unadjusted OR: 0.67, 95% CI: 0.46–0.99, p = 0.043).

Conclusion A standard dose of azithromycin provides adequate perioperative prophylaxis in class III obese patients, decreasing rates of postcesarean wound complications and unscheduled postpartum outpatient visits.

Key Points

  • Class III obese patients undergoing unscheduled cesarean have high rates of wound complications.

  • Standard-dose azithromycin reduces risk of postcesarean wound infection in class III obese patients.

  • Standard-dose azithromycin reduces readmission, unscheduled visits in class III obese patients.

Keywords

obesity - cesarean - infection - antibiotics - azithromycin


Publication History

Received: 24 April 2023

Accepted: 21 July 2023

Accepted Manuscript online:
24 July 2023

Article published online:
25 August 2023

© 2023. Thieme. All rights reserved.

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  • References

  • 1 Krieger Y, Walfisch A, Sheiner E. Surgical site infection following cesarean deliveries: trends and risk factors. J Matern Fetal Neonatal Med 2017; 30 (01) 8-12
    CrossrefPubMedGoogle Scholar
  • 2 Chaim W, Bashiri A, Bar-David J, Shoham-Vardi I, Mazor M. Prevalence and clinical significance of postpartum endometritis and wound infection. Infect Dis Obstet Gynecol 2000; 8 (02) 77-82
    CrossrefPubMedGoogle Scholar
  • 3 Perencevich EN, Sands KE, Cosgrove SE, Guadagnoli E, Meara E, Platt R. Health and economic impact of surgical site infections diagnosed after hospital discharge. Emerg Infect Dis 2003; 9 (02) 196-203
    CrossrefPubMedGoogle Scholar
  • 4 Temming LA, Raghuraman N, Carter EB. et al. Impact of evidence-based interventions on wound complications after cesarean delivery. Am J Obstet Gynecol 2017; 217 (04) 449.e1-449.e9
    CrossrefPubMedGoogle Scholar
  • 5 American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 120: use of prophylactic antibiotics in labor and delivery. Obstet Gynecol 2011; 117 (06) 1472-1483
    CrossrefPubMedGoogle Scholar
  • 6 Thigpen BD, Hood WA, Chauhan S. et al. Timing of prophylactic antibiotic administration in the uninfected laboring gravida: a randomized clinical trial. Am J Obstet Gynecol 2005; 192 (06) 1864-1868 , discussion 1868–1871
    CrossrefPubMedGoogle Scholar
  • 7 Costantine MM, Rahman M, Ghulmiyah L. et al. Timing of perioperative antibiotics for cesarean delivery: a metaanalysis. Am J Obstet Gynecol 2008; 199 (03) 301.e1-301.e6
    CrossrefPubMedGoogle Scholar
  • 8 Smid MC, Kearney MS, Stamilio DM. Extreme obesity and postcesarean wound complications in the maternal-fetal medicine unit cesarean registry. Am J Perinatol 2015; 32 (14) 1336-1341
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Tita AT, Szychowski JM, Boggess K. et al; C/SOAP Trial Consortium. Adjunctive azithromycin prophylaxis for cesarean delivery. N Engl J Med 2016; 375 (13) 1231-1241
    CrossrefPubMedGoogle Scholar
  • 10 Young OM, Shaik IH, Twedt R. et al. Pharmacokinetics of cefazolin prophylaxis in obese gravidae at time of cesarean delivery. Am J Obstet Gynecol 2015; 213 (04) 541.e1-5 -41.e7
    CrossrefPubMedGoogle Scholar
  • 11 Swank ML, Wing DA, Nicolau DP, McNulty JA. Increased 3-gram cefazolin dosing for cesarean delivery prophylaxis in obese women. Am J Obstet Gynecol 2015; 213 (03) 415.e1-415.e8
    CrossrefPubMedGoogle Scholar
  • 12 Anderson DJ, Podgorny K, Berríos-Torres SI. et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014; 35 (06) 605-627
    CrossrefPubMedGoogle Scholar
  • 13 Sutton AL, Acosta EP, Larson KB, Kerstner-Wood CD, Tita AT, Biggio JR. Perinatal pharmacokinetics of azithromycin for cesarean prophylaxis. Am J Obstet Gynecol 2015; 212 (06) 812.e1-812.e6
    CrossrefPubMedGoogle Scholar