Effect of a change in policy regarding the timing of prophylactic antibiotics on the rate of postcesarean delivery surgical-site infections

Am J Obstet Gynecol. 2008 Sep;199(3):310.e1-5. doi: 10.1016/j.ajog.2008.07.009.


Objective: The purpose of this study was to examine the effect of a change in policy regarding the timing of antibiotic administration on the rates of postcesarean delivery surgical-site infections (SSI).

Study design: This was a retrospective cohort study of 1316 term, singleton cesarean deliveries at 1 institution. A policy change was instituted wherein prophylactic antibiotics were given before skin incision rather than after cord clamp. The primary outcome that was examined was SSI; secondary outcomes were the rates of endometritis and cellulitis. Multivariable regression was performed to control for potential confounders.

Results: The overall rate of SSI fell from 6.4-2.5% (P = .002). When we controlled for potential confounders, there was a decline in overall SSI with an adjusted odds ratio (aOR) of 0.33 (95% CI, 0.14,0.76), a decrease in endometritis (aOR, 0.34; 95% CI, 0.13,0.92), and a trend towards a decrease in cellulitis (aOR, 0.22; 95% CI, 0.05,1.22).

Conclusion: At our institution, a change in policy to administer prophylactic antibiotics before skin incision led to a significant decline in postcesarean delivery SSIs.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antibiotic Prophylaxis / methods*
  • Antibiotic Prophylaxis / trends
  • Cellulitis / epidemiology
  • Cellulitis / prevention & control
  • Cesarean Section*
  • Clinical Protocols
  • Endometritis / epidemiology
  • Endometritis / prevention & control
  • Evidence-Based Medicine
  • Female
  • Humans
  • Logistic Models
  • Obstetrics and Gynecology Department, Hospital / organization & administration
  • Odds Ratio
  • Pregnancy
  • Preoperative Care*
  • Retrospective Studies
  • Surgical Wound Infection / epidemiology
  • Surgical Wound Infection / prevention & control*