Use of
alternative antibiotics other than the standard recommendation of the
first-generation cephalosporin is associated with increased risk of infection
and other adverse events, according to a new analysis of more than 6500
cesarean section deliveries. Cephazolin in the drug of choice for surgical
prophylaxis in C-section deliveries.
"Use of
both standard alternative and inappropriate alternative antibiotics was
associated with higher odds of surgical site infections compared with the use
of cefazolin for prophylaxis at the time of cesarean delivery," conclude
the authors in the study published September 7 in Journal Obstetrics &
Gynecology.
The American
College of Obstetricians and Gynecologists (ACOG) recommend an infusion of
intravenous 1 g cefazolin within 60 min before skin incision. For women with
(BMI >30 kg/m 2 or weight > 100 kg, a dose of 2 g cefazolin intravenous
infusion is recommended.
In women who
are allergic to cephalosporin ACOG recommends alternative antibiotics, such as
clindamycin combined with an aminoglycoside.
In this
retrospective cohort study conducted over a period of 5 years (2012 – 2017),
Tetsuya Kawakita, MD, Department of Obstetrics and Gynecology, MedStar
Washington Hospital Center, Washington, DC, and colleagues analyzed data from
6584 women who had cesarean delivery in their center.
Majority of
women, 6163(93.6%) received standard cefazolin, 274 (4.2%) received the
standard alternative, while 147 (2.2%) received inappropriate alternatives—
mostly clindamycin or gentamycin.
Propensity
score adjusted logistic regression showed that use of alternative antibiotic
was not associated with increased risk of the composite primary outcome namely
endometritis, cellulitis, deep-wound infection, abdominopelvic abscess, and
sepsis. But a subgroup analysis revealed that use of alternative antibiotic
increased chances of cellulitis by 93% as compared to use of cephalosporins
(adjusted odds ratio [OR], 1.93; 95% CI, 1.03 - 3.31).
Patient
receiving alternative antibiotic faced nearly twice the risk of visiting the ER
for wound complication (adjusted OR, 2.34; 95% CI, 1.19 - 4.18) compared with
cefazolin.
Similarly,
use of inappropriate antibiotics increased the odds of primary outcome nearly 4
times as compared to cephazolin (adjusted OR, 4.13; 95% CI, 2.59 - 6.36), while
odds of endometritis (adjusted OR, 6.68; 95% CI, 3.69 - 11.44) and cellulitis
(adjusted OR, 3.23; 95% CI, 1.63 - 5.81) also increased drastically.
The authors
speculated that the difference in sensitivity of skin bacterial flora to the
alternative antibiotics might be responsible for increased odds of having
cellulitis after the C-section. More studies are warranted on alternate
antibiotics other than those recommended by ACOG.
Besides, the
authors also stressed that physicians should validate the patients claim of
allergy to beta-lactam antibiotics and should not only rely on history given by
the patients. They found that only 10-20% of patients documented true allergy
on skin testing.
If patients
gave a history of nonsignificant beta-lactam allergies, use of cefazolin in
such patients might lower the risk of adverse event during cesarean delivery.
More on
prevention of sepsis during cesarean deliveries:
