Grand Rounds

Preventing Infection: Optimizing Antibiotic Regimen Post- C-Section in Obese Women

BACKGROUND AND PURPOSE:

Data on perioperative antibiotic prophylaxis in obese women undergoing cesarean section is limited
Valent et al. (JAMA, 2017) sought to determine rates of surgical site infection (SSI) among obese women who received prophylactic oral cephalexin and metronidazole vs placebo for 48 hours post surgery

Randomized, double-blind clinical trial (RCT)
Women with prepregnancy BMI ≥30 were included in this study
All women received standard preop cephalosporin prophylaxis
Two arms of the study
- Oral cephalexin (500 mg) and metronidazole (500 mg) group administered every 8 hours for total 48 hours post-surgery
- Identical-appearing placebo
Randomization was stratified by intact vs ruptured membranes
Primary outcome was SSI, defined as any superficial incisional, deep incisional, or organ/space infection within 30 days post-surgery

403 randomized participants completed the trial
Mean age, 28 (SD, 6) years
Mean BMI, 39.7 (SD, 7.8)
Overall rate of SSI was 10.9% (95% CI 7.9%-14.0%)
SSI was diagnosed in 13 women (6.4%) in the cephalexin-metronidazole group vs 31 women (15.4%) in the placebo group
- Difference, 9.0% (95% CI, 2.9%-15.0%)
- Relative risk, 0.41 (95% CI, 0.22-0.77; P = .01)

A postoperative 48-hour course of oral cephalexin and metronidazole reduced the rate of SSI within 30 days after delivery
This study supports the administration of prophylactic oral cephalexin and metronidazole for obese women after cesarean delivery

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