Impact of Azithromycin-Based Extended-Spectrum Antibiotic Prophylaxis on Noninfectious Cesarean Wound Complications

Elizabeth B. Ausbeck; Victoria C. Jauk; Kim A. Boggess; George R. Saade; Sherri Longo; Erin A. S. Clark; Sean Esplin; Kirsten Cleary; Ronald Wapner; Kellett Letson; Michelle Owens; Adi Abramovici; Namasivayam Ambalavanan; Jeff M. Szychowski; William Andrews; Alan T. N. Tita; for the Cesarean Section Optimal Antibiotic Prophylaxis Trial Consortium

doi:10.1055/s-0039-1679914

American Journal of Perinatology, Table of Contents

Am J Perinatol 2019; 36(09): 886-890
DOI: 10.1055/s-0039-1679914

SMFM Fellowship Series Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Impact of Azithromycin-Based Extended-Spectrum Antibiotic Prophylaxis on Noninfectious Cesarean Wound Complications

Elizabeth B. Ausbeck

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama

,

Victoria C. Jauk

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama

,

Kim A. Boggess

²Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina

,

George R. Saade

³Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas

,

Sherri Longo

⁴Department of Obstetrics and Gynecology, Ochsner Health System, New Orleans, Louisiana

,

Erin A. S. Clark

⁵Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah

⁶Department of Obstetrics and Gynecology, Intermountain Health Care, Salt Lake City, Utah

,

Sean Esplin

⁵Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah

⁶Department of Obstetrics and Gynecology, Intermountain Health Care, Salt Lake City, Utah

,

Kirsten Cleary

⁷Department of Obstetrics and Gynecology, Columbia University, New York, New York

,

Ronald Wapner

⁷Department of Obstetrics and Gynecology, Columbia University, New York, New York

,

Kellett Letson

⁸Department of Obstetrics and Gynecology, Mission Hospital, Asheville, North Carolina

,

Michelle Owens

⁹Department of Obstetrics and Gynecology, University of Mississippi, Jackson, Mississippi

,

Adi Abramovici

¹⁰Department of Obstetrics and Gynecology, University of Texas Health Sciences Center, Houston, Texas

,

Namasivayam Ambalavanan

¹¹Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama

,

Jeff M. Szychowski

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama

¹²Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama

,

William Andrews

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama

,

Alan T. N. Tita

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama

,

for the Cesarean Section Optimal Antibiotic Prophylaxis Trial Consortium

› Author Affiliations

Abstract

Objective Adding azithromycin to standard antibiotic prophylaxis for unscheduled cesarean delivery has been shown to reduce postcesarean infections. Because wound infection with ureaplasmas may not be overtly purulent, we assessed the hypothesis that azithromycin-based extended-spectrum antibiotic prophylaxis also reduces wound complications that are identified as noninfectious.

Study Design This is a secondary analysis of the C/SOAP (Cesarean Section Optimal Antibiotic Prophylaxis) randomized controlled trial, which enrolled women with singleton pregnancies ≥24 weeks who were undergoing nonelective cesarean. Women were randomized to adjunctive azithromycin or identical placebo up to 1 hour preincision. All wound complications occurring within 6 weeks were adjudicated into infection and noninfectious wound complications (seroma, hematoma, local cellulitis, and other noninfectious wound breakdown). The primary outcome for this analysis is the composite of noninfectious wound complications.

Results At a total of 14 sites, 2,013 women were randomized to adjunctive azithromycin (n = 1,019) or placebo (n = 994). Groups were similar at baseline. Although there was a lower rate of noninfectious wound complications in the azithromycin group compared with placebo (2.9 vs. 3.8%), this was not statistically significant (p = 0.22).

Conclusion While adding azithromycin to usual antibiotic prophylaxis for nonelective cesarean delivery does reduce the risk of postcesarean infections, it did not significantly reduce the risk of postcesarean noninfectious wound complications.

Keywords

cesarean - azithromycin - noninfectious wound - infection - wound complication

Full Text

References

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