Effect of a change in policy regarding the timing of prophylactic antibiotics on the rate of postcesarean delivery surgical-site infections

Anjali J. Kaimal, Marya G. Zlatnik, Yvonne W. Cheng, Mari Paule Thiet, Elspeth Connatty, Patricia Creedy, Aaron B. Caughey

Research output: Contribution to journalArticle

45 Scopus citations

Abstract

Objective: The purpose of this study was to examine the effect of a change in policy regarding the timing of antibiotic administration on the rates of postcesarean delivery surgical-site infections (SSI). Study Design: This was a retrospective cohort study of 1316 term, singleton cesarean deliveries at 1 institution. A policy change was instituted wherein prophylactic antibiotics were given before skin incision rather than after cord clamp. The primary outcome that was examined was SSI; secondary outcomes were the rates of endometritis and cellulitis. Multivariable regression was performed to control for potential confounders. Results: The overall rate of SSI fell from 6.4-2.5% (P = .002). When we controlled for potential confounders, there was a decline in overall SSI with an adjusted odds ratio (aOR) of 0.33 (95% CI, 0.14,0.76), a decrease in endometritis (aOR, 0.34; 95% CI, 0.13,0.92), and a trend towards a decrease in cellulitis (aOR, 0.22; 95% CI, 0.05,1.22). Conclusion: At our institution, a change in policy to administer prophylactic antibiotics before skin incision led to a significant decline in postcesarean delivery SSIs.

Original languageEnglish (US)
Pages (from-to)310.e1-310.e5
JournalAmerican journal of obstetrics and gynecology
Volume199
Issue number3
DOIs
StatePublished - Sep 2008

Keywords

  • evidence-based medicine
  • infection
  • surgical complication
  • systems-based practice

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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