Lower Odds of Post-Cesarean Maternal Infection With Azithromycin
Women of black race-ethnicity with a non-transverse uterine incision had increased odds of maternal infection.
HealthDay News — For women undergoing cesarean section, 8.8% have post-cesarean infection, with pre-incision azithromycin prophylaxis associated with reduced odds of infection, according to research published in Obstetrics & Gynecology.
Kim A. Boggess, MD, from the University of North Carolina at Chapel Hill, and colleagues conducted a secondary analysis of a randomized clinical trial involving patients at 24 weeks of gestation or greater who delivered by cesarean after 4 hours or more of ruptured membranes or labor. A total of 2013 participants received pre-incision prophylaxis and were randomly allocated to receive azithromycin (1019 women) or placebo.
The researchers found that 8.8% of participants had post-cesarean maternal infection. Compared with the reference group, women of black race-ethnicity, with a non-transverse uterine incision, with duration of membrane rupture greater than 6 hours, and with surgery duration >49 minutes had increased odds of maternal infection in the final adjusted model after controlling for azithromycin assignment (all with adjusted odds ratios of about 2). The odds of maternal infection were significantly lower with azithromycin (adjusted odds ratio, 0.4).
"Despite pre-incision azithromycin-based extended-spectrum antibiotic prophylaxis, post-cesarean maternal infection remains a significant source of morbidity," the researchers write.
Boggess KA, Tita A, Jauk V, et al; Cesarean Section Optimal Antibiotic Prophylaxis Trial Consortium. Risk factors for postcesarean maternal infection in a trial of extended-specturm antibiotic prophylaxis. Obstet Gynecol. 2017;129:481-485. doi: 10.1097/AOG.0000000000001899