The effectiveness of a cesarean delivery bundle with vaginal preparation, cefazolin, and azithromycin in reducing postoperative infections: A before-and-after study

IF 2.4 3区医学 Q2 OBSTETRICS & GYNECOLOGY International Journal of Gynecology & Obstetrics Pub Date : 2025-02-01 DOI:10.1002/ijgo.16194

Gal Cohen, Hanoch Schreiber, Yakin Amer, Hila Shalev-Ram, Or Eliner, Tal Biron-Shental, Michal Kovo

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Abstract

Objective

To evaluate the effectiveness of a cesarean delivery (CD) bundle including preoperative vaginal preparation, cefazolin and azithromycin administration, compared with cefazolin alone, in reducing postoperative infections, among women undergoing CD during the second stage of labor.

Methods

In August 2016, our departmental protocol for preventing infectious morbidity in second-stage CD was revised from preoperative intravenous 2 g cefazolin alone, to preoperative intravenous 2 g cefazolin, intravenous 500 mg azithromycin, and vaginal cleansing with povidone-iodine. In this before-and-after study, the medical records of women who underwent CD during the second stage of labor were reviewed, comparing two time periods: January 2014 to August 2016 (control group, cefazolin alone) and November 2016 to January 2021 (CD bundle group). Obstetric characteristics, postoperative infections, and neonatal outcomes were compared between groups. Composite infectious morbidity was defined as one or more of: endometritis, surgical-site infection (SSI), abscess, urinary tract infection, and postpartum fever.

Results

During the study period, there were 5265 intrapartum CD, among them 457 were during the second stage of labor. The CD bundle group (n = 331) had lower rates of endometritis, SSI, and composite infectious morbidity compared with the control group (n = 126, 1.2% vs. 4.8%, P = 0.030; 3.0% vs. 7.1%, P = 0.049, 6.9% vs. 14.3%, P = 0.014, respectively). Neonatal outcomes did not differ between groups. Multivariable regression analysis adjusted for confounders revealed that the CD bundle reduced the risk for the composite infectious outcome, with adjusted odds ratio 0.08 (95% confidence interval 0.01–0.50).

Conclusions

In second-stage CD, adding preoperative azithromycin and vaginal cleansing to cefazolin was efficacious in reducing postoperative infections.

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剖宫产捆绑阴道制剂、头孢唑林和阿奇霉素减少术后感染的有效性：一项前后对比研究。

目的：评价术前阴道准备、头孢唑林和阿奇霉素联合应用于剖宫产（CD）的效果，并与单独应用头孢唑林相比，在减少第二产程剖宫产妇女术后感染方面的效果。方法：2016年8月，我科将预防二期CD感染发病方案由术前单纯静脉注射头孢唑林2g修改为术前静脉注射头孢唑林2g +静脉注射阿奇霉素500 mg +聚维酮碘阴道清洁。在这项前后研究中，回顾了分娩第二阶段发生CD的妇女的医疗记录，比较了两个时间段：2014年1月至2016年8月（对照组，头孢唑林单独使用）和2016年11月至2021年1月（CD捆绑组）。比较两组间的产科特征、术后感染和新生儿结局。复合感染性疾病定义为子宫内膜炎、手术部位感染（SSI）、脓肿、尿路感染和产后发热的一种或多种。结果：研究期间共发生产中CD 5265例，其中产中CD 457例。与对照组相比，CD束组（n = 331）的子宫内膜炎、SSI和复合感染性发病率较低(n = 126, 1.2% vs. 4.8%, P = 0.030；3.0%比7.1%,P = 0.049, 6.9%比14.3%,P = 0.014)。新生儿结局在两组之间没有差异。校正混杂因素的多变量回归分析显示，CD包降低了复合感染结局的风险，校正优势比为0.08（95%置信区间为0.01-0.50）。结论：对于二期CD患者，术前在头孢唑林基础上加用阿奇霉素和阴道清洁可有效减少术后感染。

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来源期刊

International Journal of Gynecology & Obstetrics 医学-妇产科学

CiteScore

5.80

自引率

2.60%

发文量

493

审稿时长

3-6 weeks

期刊介绍： The International Journal of Gynecology & Obstetrics publishes articles on all aspects of basic and clinical research in the fields of obstetrics and gynecology and related subjects, with emphasis on matters of worldwide interest.