Risk Factors for Postcesarean Maternal Infection in a Trial of Extended-Spectrum Antibiotic Prophylaxis. Issue 3 (March 2017)

• Record Type: Journal Article
• Authors: Boggess, Kim A.; Tita, Alan; Jauk, Victoria; Saade, George; Longo, Sherri; Clark, Erin A. S.; Esplin, Sean; Cleary, Kristin; Wapner, Ronald; Letson, Kelli; Owens, Michelle; Blackwell, Sean; Beamon, Carmen; Szychowski, Jeffrey M.; Andrews, William
• Is Part Of: Obstetrics and gynecology. Volume 129:Issue 3(2017)
• Publication Date: 2017-03
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1097/AOG.0000000000001899
• Languages: English
• ISSNs: 0029-7844

Abstract

Abstract : OBJECTIVE: To identify maternal clinical risk factors for postcesarean maternal infection in a randomized clinical trial of preincision extended-spectrum antibiotic prophylaxis. METHODS: We conducted a planned secondary analysis of a randomized clinical trial. Patients were 24 weeks of gestation or greater and delivered by cesarean after a minimum of 4 hours of ruptured membranes or labor. All participants received standard preincision prophylaxis and were randomized to receive azithromycin or placebo. The primary outcome for this analysis is maternal infection: a composite outcome of endometritis, wound infection (superficial or deep), or other infections occurring up to 6 weeks postpartum. Maternal clinical characteristics associated with maternal infection, after controlling for azithromycin assignment, were identified. These maternal factors were included in a multivariable logistic regression model for maternal infection. RESULTS: Of 2, 013 patients, 1, 019 were randomized to azithromycin. Overall, 177 (8.8%) had postcesarean maternal infection. In the final adjusted model, compared with the reference groups, women of black race–ethnicity, with a nontransverse uterine incision, with duration of membrane rupture greater than 6 hours, and surgery duration greater than 49 minutes, were associated higher odds of maternal infection (all with adjusted odds ratios [ORs] of approximately 2); azithromycin was associated with lower odds of maternal infection (adjusted OR 0.4, 95% confidence interval 0.3–0.6). CONCLUSION: Despite preincision azithromycin-based extended-spectrum antibiotic prophylaxis, postcesarean maternal infection remains a significant source of morbidity. Recognition of risk factors may help guide innovative prevention strategies. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, https://clinicaltrials.gov, NCT012235546. Abstract : Black race–ethnicity, a nontransverse uterine incision, ruptured membranes greater than 6 hours, and surgery longer than 49 minutes are associated with postcesarean infection.