Post-cesarean delivery infectious morbidity: Focus on preoperative antibiotics and methicillin-resistant Staphylococcus aureus

Am J Infect Control. 2010 Oct;38(8):612-6. doi: 10.1016/j.ajic.2010.02.013. Epub 2010 Jun 3.

Abstract

Background: Randomized controlled trials show that administering preoperative antibiotics prior to cesarean delivery (CD) significantly reduces the incidence of post-CD infectious morbidity. Methicillin-resistant Staphylococcus aureus (MRSA) has become prevalent in obstetrics and gynecology. The objective of this trial is to examine infectious morbidity in a clinical setting before versus after implementation of a preoperative antibiotic policy and, further, to describe the organisms cultured from CD wound infections.

Methods: We used a retrospective chart review of women delivering by CD before and after implementation of preoperative antibiotic policy.

Results: Prior to instituting the preoperative antibiotic policy, the incidence of post-CD infectious morbidity was 20.7% and dropped to 8.5% after the policy was established (P < .001). Study cohorts were similar (P > .05) in several risk factors for infection. MRSA was the most common organism isolated from post-CD wound infections (18/34, 53%). Endomyometritis accounted for the majority of post-CD infections (143/191, 74.9%), and most infections occurred within 7 days of CD (170/191, 89.0%).

Conclusion: The incidence of post-CD infectious complications decreased after a policy of administering preoperative antibiotics was instituted. MRSA was the most common organism isolated from post-CD wound infections. Further studies into the benefit of MRSA coverage in CD preoperative antibiotic regimens are needed.

MeSH terms

  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / therapeutic use
  • Antibiotic Prophylaxis*
  • Cephalosporins / administration & dosage
  • Cephalosporins / therapeutic use
  • Cesarean Section*
  • Cohort Studies
  • Cross Infection / drug therapy
  • Cross Infection / epidemiology*
  • Cross Infection / prevention & control
  • Drug Administration Schedule
  • Female
  • Humans
  • Incidence
  • Infection Control
  • Methicillin Resistance
  • Methicillin-Resistant Staphylococcus aureus / isolation & purification*
  • Postoperative Complications / drug therapy
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / prevention & control
  • Pregnancy
  • Preoperative Care
  • Retrospective Studies
  • Staphylococcal Infections / drug therapy
  • Staphylococcal Infections / epidemiology*
  • Staphylococcal Infections / prevention & control
  • Surgical Wound Infection / drug therapy
  • Surgical Wound Infection / epidemiology*
  • Surgical Wound Infection / prevention & control
  • Texas / epidemiology
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents
  • Cephalosporins