Surgical Antimicrobial Prophylaxis After Umbilical Cord Clamping Does Not Increase SSI

Team of doctors and nurses wear masks and gloves and prepare for surgery.
Study authors sought to determine whether surgical antimicrobial prophylaxis administration following cord clamping led to an increase risk of surgical site infections.

Surgical antimicrobial prophylaxis (SAP) given after umbilical cord clamping did not increase surgical site infection (SSI) in women undergoing cesarean section compared with SAP given before incision, according to results published in Antimicrobial Resistance and Infection Control.

This cohort study analyzed 55,901 patients from 75 hospitals between 2008 and 2018. SAP was given before incision in 26,405 patients (47.2%) and after cord clamping in 29,496 patients (52.8%). Of the 846 SSIs identified, 550 (65.0%) were superficial wound infections, 226 (26.7%) were organ space infections, and 70 (8.3%) were deep wound infections.

A total of 379 patients (1.6%) who received SAP before incision had an SSI, compared with 449 patients (1.7%) who received SAP after clamping (P =.759). When stratified for depth of infection, there were no differences in the SSI rates between groups.

Analyses showed that SAP administration after clamping was not significantly associated with an increased rate of SSI (adjusted odds ratio [aOR], 1.14; 95% CI, 0.96-1.36; P =.144), superficial wound infections (aOR, 1.16; 95% CI, 0.93-1.44; P =.180), or a combined endpoint of deep wound infections and endometritis (aOR, 1.07; 95% CI, 0.80-1.42; P =.661).

The study was limited in that the exact timing of clamping was unavailable and administration after incision was used as a surrogate marker, the investigators noted. Additional data concerning antimicrobial treatment pre- and post-surgery, group B streptococcal carriage, multiple pregnancy, and vaginal disinfection were also not routinely recorded.

According to investigators, this large prospective analytic study had excellent follow-up and was unable to demonstrate additional risk if SAP was delayed until after cord clamping. “Our results show a basically unchanged SSI risk whether SAP is administered before or after clamping,” the investigators concluded.


Sommerstein R, Marschall J, Atkinson A, et al. Antimicrobial prophylaxis administration after umbilical cord clamping in cesarean section and the risk of surgical site infection: a cohort study with 55,901 patients. Antimicrob Resist Infect Control. 2020;9(1):201. doi:10.1186/s13756-020-00860-0.