Hematoma and seroma | Wound dehiscence (greater than 1 cm) | Any main emergency department (ED) visit postpartum period | Main ED visit as a result of wound complication (infection, hematoma and seroma, or dehiscence) | Any hospital readmission occurring up to 6 weeks after surgery
Confounding was addressed using propensity score-adjusted logistic regression models
6,584 cases identified
Cefazolin: 6,163 (93.6%)
Standard alternative: 274 (4.2%)
Inappropriate alternatives: 147 (2.2%)
Use of standard alternative antibiotics compared with cefazolin was not associated with increased odds of the primary outcome
Crude odds ratio (OR) 1.50; 95% CI, 0.92–2.46
Adjusted OR 1.63; 95% CI, 0.97–2.60
Standard alternatives were associated with increased odds of cellulitis compared to cefazolin
Crude OR 2.07; 95% CI, 1.16–3.70
Adjusted OR 1.93; 95% CI, 1.03–3.31
Excluding women (1) who delivered after azithromycin was made available (2) with HIV or (3) who used illicit drugs resulted in similar findings
Use of inappropriate alternative antibiotics compared with cefazolin was associated with increased odds of
The primary outcome
Crude OR 4.37; 95% CI, 2.80–6.83
Adjusted OR 4.13; 95% CI, 2.59–6.36
Endometritis before discharge
Crude OR 6.85; 95% CI, 3.94–11.90
Adjusted OR 6.68; 95% CI, 3.69–11.44
Crude OR 3.36; 95% CI, 1.78–6.34
Adjusted OR 3.23; 95% CI, 1.63–5.81
Cefazolin was associated with a reduced risk of surgical site infections, compared to both standard and inappropriate alternatives
Inappropriate alternatives were especially problematic and associated with higher odds of wound complications
The authors note that only 10 to 20% of women who self-report β-lactam allergy truly have an allergy and they further state that
A thorough evaluation of patient-reported β-lactam allergy and adherence to ACOG-recommended antibiotic regimen may lower the rates of postcesarean surgical site infections. Further studies that examine alternatives to ACOG-recommended alternative antibiotics would be useful.
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
NOT ENOUGH CME HOURS
It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan