Perioperative Antibiotics and Other Factors Associated with Postcesarean Infections: A Case-Control Study

Cassandra R. Duffy; Matthew Oberhardt; Naima Ross; Julie Ewing; Maria Messina; Kelly Fitzgerald; Lisa Saiman; Dena Goffman

doi:10.1055/a-1904-9583

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2024; 41(S 01): e520-e527
DOI: 10.1055/a-1904-9583

Original Article

Perioperative Antibiotics and Other Factors Associated with Postcesarean Infections: A Case-Control Study

Cassandra R. Duffy

¹Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York

,

Matthew Oberhardt

¹Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York

²NewYork-Presbyterian Value Institute, New York, New York

,

Naima Ross

³Columbia University Vagelos College of Physicians and Surgeons, New York, New York

,

Julie Ewing

²NewYork-Presbyterian Value Institute, New York, New York

,

Maria Messina

⁴Department of Pediatrics, Columbia University Irving Medical Center, New York, New York

⁵Department of Infection Prevention and Control, New York-Presbyterian Hospital, New York, New York

,

Kelly Fitzgerald

⁶Department of Quality and Patient Safety, New York-Presbyterian Hospital, New York, New York

,

Lisa Saiman

⁴Department of Pediatrics, Columbia University Irving Medical Center, New York, New York

⁵Department of Infection Prevention and Control, New York-Presbyterian Hospital, New York, New York

,

Dena Goffman

¹Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York

⁶Department of Quality and Patient Safety, New York-Presbyterian Hospital, New York, New York

› Institutsangaben

Abstract

Objective Our objective was to determine modifiable risk factors associated with surgical site infection (SSI) and postpartum endometritis. We hypothesized that inappropriate surgical antibiotic prophylaxis would be a risk factor for both types of infections.

Study Design This was a single-center case-control study of SSI and endometritis after cesarean delivery over a 2-year period from 2016 to 2017. Cases were identified by International Classification of Diseases, 10th Revision diagnosis codes, infection control surveillance, and electronic medical records search and were subsequently confirmed by chart review. Three controls were randomly selected for each case from all cesareans ± 48 hours from case delivery. Demographic, pregnancy, and delivery characteristics were abstracted. Separate multivariable logistic regression models were used to assess factors associated with SSI and endometritis. Postpartum outcomes, including length of stay and readmission, were also compared.

Results We identified 141 cases of SSI and endometritis with an overall postpartum infection rate of 4.0% among all cesarean deliveries. In adjusted analysis, factors associated with both SSI and endometritis were intrapartum delivery, classical or other (non–low-transverse) uterine incision, and blood transfusion. Factors associated with SSI only included inadequate antibiotic prophylaxis, public insurance, hypertensive disorder of pregnancy, and nonchlorhexidine abdominal preparation; factors only associated with endometritis included β-lactam allergy, anticoagulation therapy, and chorioamnionitis. Among cases, 34% of those with SSI and 25% of those with endometritis did not receive adequate antibiotic prophylaxis, compared with 12.9 and 13.5% in control groups, respectively. Failure to receive appropriate antibiotic prophylaxis was associated with an increased risk of SSI (adjusted odds ratio [aOR]: 4.4, 95% confidence interval [CI]: 1.3–15.6) but not endometritis (aOR 0.9, 95% CI 0.4–2.0).

Conclusion Inadequate surgical antibiotic prophylaxis was associated with an increased risk of SSI but not postpartum endometritis, highlighting the different mechanisms of these infections and the importance of prioritizing adequate surgical prophylaxis. Additional potentially modifiable factors which emerged included blood transfusion and chlorhexidine skin preparation.

Key Points

Inadequate antibiotic prophylaxis is associated with a four-fold risk in surgical site infections.
The most common cause for failure to achieve adequate surgical prophylaxis was inappropriate timing of antibiotics at or after skin incision.
Blood transfusions are strongly associated (>10-fold risk) with both SSI and endometritis.

Keywords

cesarean - infection - endometritis - antibiotic prophylaxis

Volltext

Referenzen

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