Azithromycin-based Extended-Spectrum Antibiotic Prophylaxis for Cesarean: Role of Placental Colonization with Genital Ureaplasmas and Mycoplasmas

Akila Subramaniam; Ken B. Waites; Victoria C. Jauk; Joseph R. Biggio; Amelia L. M. Sutton; Jeff M. Szychowski; William W. Andrews; Alan T. N. Tita

doi:10.1055/s-0038-1675766

American Journal of Perinatology, Table of Contents

Am J Perinatol 2019; 36(10): 1002-1008
DOI: 10.1055/s-0038-1675766

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Azithromycin-based Extended-Spectrum Antibiotic Prophylaxis for Cesarean: Role of Placental Colonization with Genital Ureaplasmas and Mycoplasmas

Authors

Akila Subramaniam

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
Ken B. Waites

²Division of Laboratory Medicine, Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
Victoria C. Jauk

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
Joseph R. Biggio

³Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Ochsner Health System, New Orleans, Louisiana
Amelia L. M. Sutton

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
Jeff M. Szychowski

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
William W. Andrews

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
Alan T. N. Tita

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama

Abstract

Objective To explore whether the effect of azithromycin (AZI) on postcesarean infections varied by the presence/absence of genital mycoplasmataceae placental colonization.

Study Design This was a single-center substudy of multicenter double-blind C/SOAP (Cesarean Section Optimal Antibiotic Prophylaxis) trial of women randomized to AZI or placebo (+cefazolin) antibiotic prophylaxis at cesarean. Chorioamnion/placenta specimens were tested for genital mycoplasmataceae colonization by polymerase chain reaction. Primary outcome was a composite of endometritis, wound infection, or other infections up to 6 weeks postpartum. Analysis was intent-to-treat; logistic regression was used to evaluate interactions between treatment assignment (AZI/placebo) and the presence/absence of mycoplasmataceae and to quantify effects of AZI in analyses stratified by the presence/absence of these microorganisms.

Results Specimens from 613 women (303 AZI and 310 placebo) were evaluated. Baseline characteristics were similar between groups, and approximately 1/3 (30.3%) had mycoplasmataceae placental/chorioamnion colonization. There was no evidence of effect modification (p _interaction = 0.79) between treatment assignment and the presence/absence of organisms. Stratified analyses showed fewer events in the AZI group in the presence (odds ratio [OR]: 0.42; 95% confidence interval [CI]: 0.17–1.01) and absence (OR: 0.49; 95% CI: 0.24–1) of mycoplasmataceae. Results were similar with endometritis/wound infections and with ureaplasmas/mycoplasmas considered separately.

Conclusion The reduction in postcesarean infection with AZI does not vary based on the presence or absence of genital mycoplasmataceae placental colonization.

Keywords

antibiotic prophylaxis - azithromycin - cesarean - infection - ureaplasmas

Full Text

References

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