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Am J Perinatol 2019; 36(10): 1002-1008
DOI: 10.1055/s-0038-1675766
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Azithromycin-based Extended-Spectrum Antibiotic Prophylaxis for Cesarean: Role of Placental Colonization with Genital Ureaplasmas and Mycoplasmas

Akila Subramaniam
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
,
Ken B. Waites
2   Division of Laboratory Medicine, Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
,
Victoria C. Jauk
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
,
Joseph R. Biggio
3   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Ochsner Health System, New Orleans, Louisiana
,
Amelia L. M. Sutton
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
,
Jeff M. Szychowski
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
,
William W. Andrews
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
,
Alan T. N. Tita
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
› Author Affiliations Funding The authors acknowledge financial support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant #HD64729). The azithromycin used in the parent study was provided by Pfizer through an investigator-initiated grant.
Further Information

Publication History

04 October 2018

08 October 2018

Publication Date:
30 November 2018 (online)

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Abstract

Objective To explore whether the effect of azithromycin (AZI) on postcesarean infections varied by the presence/absence of genital mycoplasmataceae placental colonization.

Study Design This was a single-center substudy of multicenter double-blind C/SOAP (Cesarean Section Optimal Antibiotic Prophylaxis) trial of women randomized to AZI or placebo (+cefazolin) antibiotic prophylaxis at cesarean. Chorioamnion/placenta specimens were tested for genital mycoplasmataceae colonization by polymerase chain reaction. Primary outcome was a composite of endometritis, wound infection, or other infections up to 6 weeks postpartum. Analysis was intent-to-treat; logistic regression was used to evaluate interactions between treatment assignment (AZI/placebo) and the presence/absence of mycoplasmataceae and to quantify effects of AZI in analyses stratified by the presence/absence of these microorganisms.

Results Specimens from 613 women (303 AZI and 310 placebo) were evaluated. Baseline characteristics were similar between groups, and approximately 1/3 (30.3%) had mycoplasmataceae placental/chorioamnion colonization. There was no evidence of effect modification (p interaction = 0.79) between treatment assignment and the presence/absence of organisms. Stratified analyses showed fewer events in the AZI group in the presence (odds ratio [OR]: 0.42; 95% confidence interval [CI]: 0.17–1.01) and absence (OR: 0.49; 95% CI: 0.24–1) of mycoplasmataceae. Results were similar with endometritis/wound infections and with ureaplasmas/mycoplasmas considered separately.

Conclusion The reduction in postcesarean infection with AZI does not vary based on the presence or absence of genital mycoplasmataceae placental colonization.

Keywords

antibiotic prophylaxis - azithromycin - cesarean - infection - ureaplasmas

Note

This study was presented at the 36th Annual Pregnancy Meeting of the Society for Maternal-Fetal Medicine, The Pregnancy Meeting, Atlanta, GA, February 1–6, 2016 (Abstract #102).