Risk factors for postcesarean maternal infection in a trial of extended-spectrum antibiotic prophylaxis

Kim A. Boggess, Alan Tita, Victoria Jauk, George Saade, Sherri Longo, Erin A S Clark, Sean Esplin, Kristin Cleary, Ronald Wapner, Kelli Letson, Michelle Owens, Sean Blackwell, Carmen Beamon, Jeffrey M. Szychowski, William Andrews

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

OBJECTIVE: To identify maternal clinical risk factors for postcesarean maternal infection in a randomized clinical trial of preincision extended-spectrum antibiotic prophylaxis. METHODS: We conducted a planned secondary analysis of a randomized clinical trial. Patients were 24 weeks of gestation or greater and delivered by cesarean after a minimum of 4 hours of ruptured membranes or labor. All participants received standard preincision prophylaxis and were randomized to receive azithromycin or placebo. The primary outcome for this analysis is maternal infection: a composite outcome of endometritis, wound infection (superficial or deep), or other infections occurring up to 6 weeks postpartum. Maternal clinical characteristics associated with maternal infection, after controlling for azithromycin assignment, were identified. These maternal factors were included in a multivariable logistic regression model for maternal infection. RESULTS: Of 2,013 patients, 1,019 were randomized to azithromycin. Overall, 177 (8.8%) had postcesarean maternal infection. In the final adjusted model, compared with the reference groups, women of black race-ethnicity, with a nontransverse uterine incision, with duration of membrane rupture greater than 6 hours, and surgery duration greater than 49 minutes, were associated higher odds of maternal infection (all with adjusted odds ratios [ORs] of approximately 2); azithromycin was associated with lower odds of maternal infection (adjusted OR 0.4, 95% confidence interval 0.3-0.6). CONCLUSION: Despite preincision azithromycin-based extended-spectrum antibiotic prophylaxis, postcesarean maternal infection remains a significant source of morbidity. Recognition of risk factors may help guide innovative prevention strategies.

Original languageEnglish (US)
Pages (from-to)481-485
Number of pages5
JournalObstetrics and Gynecology
Volume129
Issue number3
DOIs
StatePublished - 2017

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Antibiotic Prophylaxis
Mothers
Azithromycin
Infection
Randomized Controlled Trials
Logistic Models
Odds Ratio
Endometritis
Membranes
Wound Infection
Postpartum Period
Rupture
Placebos
Confidence Intervals
Morbidity

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Risk factors for postcesarean maternal infection in a trial of extended-spectrum antibiotic prophylaxis. / Boggess, Kim A.; Tita, Alan; Jauk, Victoria; Saade, George; Longo, Sherri; Clark, Erin A S; Esplin, Sean; Cleary, Kristin; Wapner, Ronald; Letson, Kelli; Owens, Michelle; Blackwell, Sean; Beamon, Carmen; Szychowski, Jeffrey M.; Andrews, William.

In: Obstetrics and Gynecology, Vol. 129, No. 3, 2017, p. 481-485.

Research output: Contribution to journalArticle

Boggess, KA, Tita, A, Jauk, V, Saade, G, Longo, S, Clark, EAS, Esplin, S, Cleary, K, Wapner, R, Letson, K, Owens, M, Blackwell, S, Beamon, C, Szychowski, JM & Andrews, W 2017, 'Risk factors for postcesarean maternal infection in a trial of extended-spectrum antibiotic prophylaxis', Obstetrics and Gynecology, vol. 129, no. 3, pp. 481-485. https://doi.org/10.1097/AOG.0000000000001899
Boggess, Kim A. ; Tita, Alan ; Jauk, Victoria ; Saade, George ; Longo, Sherri ; Clark, Erin A S ; Esplin, Sean ; Cleary, Kristin ; Wapner, Ronald ; Letson, Kelli ; Owens, Michelle ; Blackwell, Sean ; Beamon, Carmen ; Szychowski, Jeffrey M. ; Andrews, William. / Risk factors for postcesarean maternal infection in a trial of extended-spectrum antibiotic prophylaxis. In: Obstetrics and Gynecology. 2017 ; Vol. 129, No. 3. pp. 481-485.
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AU - Longo, Sherri

AU - Clark, Erin A S

AU - Esplin, Sean

AU - Cleary, Kristin

AU - Wapner, Ronald

AU - Letson, Kelli

AU - Owens, Michelle

AU - Blackwell, Sean

AU - Beamon, Carmen

AU - Szychowski, Jeffrey M.

AU - Andrews, William

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N2 - OBJECTIVE: To identify maternal clinical risk factors for postcesarean maternal infection in a randomized clinical trial of preincision extended-spectrum antibiotic prophylaxis. METHODS: We conducted a planned secondary analysis of a randomized clinical trial. Patients were 24 weeks of gestation or greater and delivered by cesarean after a minimum of 4 hours of ruptured membranes or labor. All participants received standard preincision prophylaxis and were randomized to receive azithromycin or placebo. The primary outcome for this analysis is maternal infection: a composite outcome of endometritis, wound infection (superficial or deep), or other infections occurring up to 6 weeks postpartum. Maternal clinical characteristics associated with maternal infection, after controlling for azithromycin assignment, were identified. These maternal factors were included in a multivariable logistic regression model for maternal infection. RESULTS: Of 2,013 patients, 1,019 were randomized to azithromycin. Overall, 177 (8.8%) had postcesarean maternal infection. In the final adjusted model, compared with the reference groups, women of black race-ethnicity, with a nontransverse uterine incision, with duration of membrane rupture greater than 6 hours, and surgery duration greater than 49 minutes, were associated higher odds of maternal infection (all with adjusted odds ratios [ORs] of approximately 2); azithromycin was associated with lower odds of maternal infection (adjusted OR 0.4, 95% confidence interval 0.3-0.6). CONCLUSION: Despite preincision azithromycin-based extended-spectrum antibiotic prophylaxis, postcesarean maternal infection remains a significant source of morbidity. Recognition of risk factors may help guide innovative prevention strategies.

AB - OBJECTIVE: To identify maternal clinical risk factors for postcesarean maternal infection in a randomized clinical trial of preincision extended-spectrum antibiotic prophylaxis. METHODS: We conducted a planned secondary analysis of a randomized clinical trial. Patients were 24 weeks of gestation or greater and delivered by cesarean after a minimum of 4 hours of ruptured membranes or labor. All participants received standard preincision prophylaxis and were randomized to receive azithromycin or placebo. The primary outcome for this analysis is maternal infection: a composite outcome of endometritis, wound infection (superficial or deep), or other infections occurring up to 6 weeks postpartum. Maternal clinical characteristics associated with maternal infection, after controlling for azithromycin assignment, were identified. These maternal factors were included in a multivariable logistic regression model for maternal infection. RESULTS: Of 2,013 patients, 1,019 were randomized to azithromycin. Overall, 177 (8.8%) had postcesarean maternal infection. In the final adjusted model, compared with the reference groups, women of black race-ethnicity, with a nontransverse uterine incision, with duration of membrane rupture greater than 6 hours, and surgery duration greater than 49 minutes, were associated higher odds of maternal infection (all with adjusted odds ratios [ORs] of approximately 2); azithromycin was associated with lower odds of maternal infection (adjusted OR 0.4, 95% confidence interval 0.3-0.6). CONCLUSION: Despite preincision azithromycin-based extended-spectrum antibiotic prophylaxis, postcesarean maternal infection remains a significant source of morbidity. Recognition of risk factors may help guide innovative prevention strategies.

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