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Antibiotics for Cesarean: Update on Prophylaxis

Antibiotics for Cesarean: Update on Prophylaxis T. Flint, MD MPH. 02/11/2019. Park City, Utah Background million cesareans in US annually 1 in 3 deliveries Surgical site infection (SSI) is the most common complication SSI includes Wound infection Endometritis Intrabdominal abscess Risk Factors for SSI. Obesity Chorioamnionitis (Triple I, IAI). Cesarean with labor Spontaneous Induction Emergency cesarean without labor Maternal comorbidities Diabetes Autoimmune conditions Preeclampsia Saed et al, Am J Infect Cont, 2019. SSI is expensive $3,400 - $4,000/SSI. $500 million/Year Olsen. Infect Control Hosp Epidemiol. 2010. Prophylaxis Preoperative vaginal prep Pre-incision Antibiotics Gentle cord traction vs. manual removal Subcutaneous closure > 2 cm Suture skin closure Antibiotics in special circumstances CS after labor, ROM. Obesity Chorioamnionitis (Triple I, etc.). Sood, Curr Opin Infect Dis 2018, TODAY'S FOCUS: antibiotic Prophylaxis .

Vaginal Cleansing Meta-analysis and Systematic Review, 2017 • Assess the efficacy of vaginal cleansing before cesarean delivery in reducing PPE • RCTs comparing vaginal cleansing vs placebo or no intervention –15 RCTs with 4,744 women included • Subgroup analysis –Labor vs. no labor –Membrane status –Type of antiseptic solution

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