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Am J Perinatol 2019; 36(09): 886-890
DOI: 10.1055/s-0039-1679914
SMFM Fellowship Series Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Impact of Azithromycin-Based Extended-Spectrum Antibiotic Prophylaxis on Noninfectious Cesarean Wound Complications

Elizabeth B. Ausbeck
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Victoria C. Jauk
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Kim A. Boggess
2   Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
,
George R. Saade
3   Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
,
Sherri Longo
4   Department of Obstetrics and Gynecology, Ochsner Health System, New Orleans, Louisiana
,
Erin A. S. Clark
5   Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
6   Department of Obstetrics and Gynecology, Intermountain Health Care, Salt Lake City, Utah
,
Sean Esplin
5   Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
6   Department of Obstetrics and Gynecology, Intermountain Health Care, Salt Lake City, Utah
,
Kirsten Cleary
7   Department of Obstetrics and Gynecology, Columbia University, New York, New York
,
Ronald Wapner
7   Department of Obstetrics and Gynecology, Columbia University, New York, New York
,
Kellett Letson
8   Department of Obstetrics and Gynecology, Mission Hospital, Asheville, North Carolina
,
Michelle Owens
9   Department of Obstetrics and Gynecology, University of Mississippi, Jackson, Mississippi
,
Adi Abramovici
10   Department of Obstetrics and Gynecology, University of Texas Health Sciences Center, Houston, Texas
,
Namasivayam Ambalavanan
11   Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
,
Jeff M. Szychowski
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
12   Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
,
William Andrews
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Alan T. N. Tita
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
for the Cesarean Section Optimal Antibiotic Prophylaxis Trial Consortium› Author Affiliations
Funding The original trial was supported by a grant (HD64729) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The azithromycin used in the study was provided by Pfizer through an investigator-initiated grant.
Further Information

Publication History

19 September 2018

17 January 2019

Publication Date:
19 February 2019 (online)

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Abstract

Objective Adding azithromycin to standard antibiotic prophylaxis for unscheduled cesarean delivery has been shown to reduce postcesarean infections. Because wound infection with ureaplasmas may not be overtly purulent, we assessed the hypothesis that azithromycin-based extended-spectrum antibiotic prophylaxis also reduces wound complications that are identified as noninfectious.

Study Design This is a secondary analysis of the C/SOAP (Cesarean Section Optimal Antibiotic Prophylaxis) randomized controlled trial, which enrolled women with singleton pregnancies ≥24 weeks who were undergoing nonelective cesarean. Women were randomized to adjunctive azithromycin or identical placebo up to 1 hour preincision. All wound complications occurring within 6 weeks were adjudicated into infection and noninfectious wound complications (seroma, hematoma, local cellulitis, and other noninfectious wound breakdown). The primary outcome for this analysis is the composite of noninfectious wound complications.

Results At a total of 14 sites, 2,013 women were randomized to adjunctive azithromycin (n = 1,019) or placebo (n = 994). Groups were similar at baseline. Although there was a lower rate of noninfectious wound complications in the azithromycin group compared with placebo (2.9 vs. 3.8%), this was not statistically significant (p = 0.22).

Conclusion While adding azithromycin to usual antibiotic prophylaxis for nonelective cesarean delivery does reduce the risk of postcesarean infections, it did not significantly reduce the risk of postcesarean noninfectious wound complications.

Keywords

cesarean - azithromycin - noninfectious wound - infection - wound complication