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

Elizabeth B. Ausbeck, Victoria C. Jauk, Kim A. Boggess, George Saade, Sherri Longo, Erin A.S. Clark, Sean Esplin, Kirsten Cleary, Ronald Wapner, Kellett Letson, Michelle Owens, Adi Abramovici, Namasivayam Ambalavanan, Jeff M. Szychowski, William Andrews, Alan T.N. Tita

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)886-890
Number of pages5
JournalAmerican Journal of Perinatology
Volume36
Issue number9
DOIs
StatePublished - Jan 1 2019

Fingerprint

Azithromycin
Antibiotic Prophylaxis
Wounds and Injuries
Placebos
Wound Infection
Ureaplasma
Seroma
Cellulitis
Infection
Cesarean Section
Hematoma
Randomized Controlled Trials
Pregnancy

Keywords

  • azithromycin
  • cesarean
  • infection
  • noninfectious wound
  • wound complication

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

Impact of Azithromycin-Based Extended-Spectrum Antibiotic Prophylaxis on Noninfectious Cesarean Wound Complications. / Ausbeck, Elizabeth B.; Jauk, Victoria C.; Boggess, Kim A.; Saade, George; Longo, Sherri; Clark, Erin A.S.; Esplin, Sean; Cleary, Kirsten; Wapner, Ronald; Letson, Kellett; Owens, Michelle; Abramovici, Adi; Ambalavanan, Namasivayam; Szychowski, Jeff M.; Andrews, William; Tita, Alan T.N.

In: American Journal of Perinatology, Vol. 36, No. 9, 01.01.2019, p. 886-890.

Research output: Contribution to journalArticle

Ausbeck, EB, Jauk, VC, Boggess, KA, Saade, G, Longo, S, Clark, EAS, Esplin, S, Cleary, K, Wapner, R, Letson, K, Owens, M, Abramovici, A, Ambalavanan, N, Szychowski, JM, Andrews, W & Tita, ATN 2019, 'Impact of Azithromycin-Based Extended-Spectrum Antibiotic Prophylaxis on Noninfectious Cesarean Wound Complications', American Journal of Perinatology, vol. 36, no. 9, pp. 886-890. https://doi.org/10.1055/s-0039-1679914
Ausbeck, Elizabeth B. ; Jauk, Victoria C. ; Boggess, Kim A. ; Saade, George ; Longo, Sherri ; Clark, Erin A.S. ; Esplin, Sean ; Cleary, Kirsten ; Wapner, Ronald ; Letson, Kellett ; Owens, Michelle ; Abramovici, Adi ; Ambalavanan, Namasivayam ; Szychowski, Jeff M. ; Andrews, William ; Tita, Alan T.N. / Impact of Azithromycin-Based Extended-Spectrum Antibiotic Prophylaxis on Noninfectious Cesarean Wound Complications. In: American Journal of Perinatology. 2019 ; Vol. 36, No. 9. pp. 886-890.
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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.",
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T1 - Impact of Azithromycin-Based Extended-Spectrum Antibiotic Prophylaxis on Noninfectious Cesarean Wound Complications

AU - Ausbeck, Elizabeth B.

AU - Jauk, Victoria C.

AU - Boggess, Kim A.

AU - Saade, George

AU - Longo, Sherri

AU - Clark, Erin A.S.

AU - Esplin, Sean

AU - Cleary, Kirsten

AU - Wapner, Ronald

AU - Letson, Kellett

AU - Owens, Michelle

AU - Abramovici, Adi

AU - Ambalavanan, Namasivayam

AU - Szychowski, Jeff M.

AU - Andrews, William

AU - Tita, Alan T.N.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - azithromycin

KW - cesarean

KW - infection

KW - noninfectious wound

KW - wound complication

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