Comparing prophylactic use of cefazolin for SSI in cesarean section: a systematic review and meta-analysis

Arch Gynecol Obstet. 2021 Feb;303(2):313-320. doi: 10.1007/s00404-020-05873-z. Epub 2020 Nov 26.


Purpose: To summarize the available evidence to explore the effect of different prophylactic cefazolin regimens on postoperative surgical site infection after cesarean section.

Methods: We searched WOS, Pubmed, and EMBASE Database also traced citations in the reference sections of the retrieved studies. English search words: Cesarean section, Surgical site infection, Cefazolin. The majority of the literature are randomized controlled trials comparing varied regimens of cefazolin.

Results: A total of 11 randomized controlled trials and 4 non-randomized controlled trials involving 16,328 pregnant women were eligible. There was no statistically significant difference in the risk of SSI after cesarean section when cefazolin was given at a high dose compared with cefazolin at a low dose (OR 0.77, 95% CI 0.57-1.04, I2 = 0.0%). The risk of SSI after cesarean section was reduced by prophylactic use of cefazolin before skin incision compared with that after the umbilical cord clamping (OR 0.48, 95% CI 0.29-0.82, I2 = 53.4%). Because of the extreme heterogeneity of the combined drug use, no meta-analysis results were provided. The consequences of cefazolin combined with other antibiotics (either orally or intravenously) vary widely. For pregnant women with different risk factors, cefazolin alone or the type, dose and drug route of cefazolin combined with additional antibiotics need to be further studied and explored.

Conclusions: All in all, this article illustrates a better use of cefazolin for the control of Surgical incision site infection in the cesarean section. For pregnant women with cesarean section without high-risk factors of infection, the use of cefazolin is effective, but for pregnant women with different high-risk factors, the specific use of prophylactic antibiotics needs to be further explored.

Keywords: Cefazolin; Cesarean section; Surgical site infection.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Anti-Bacterial Agents / administration & dosage*
  • Antibiotic Prophylaxis / adverse effects
  • Antibiotic Prophylaxis / methods*
  • Bacterial Infections / prevention & control*
  • Cefazolin / administration & dosage*
  • Cesarean Section / adverse effects
  • Dose-Response Relationship, Drug
  • Female
  • Humans
  • Postoperative Complications / prevention & control*
  • Pregnancy
  • Risk Factors
  • Surgical Wound Infection / prevention & control


  • Anti-Bacterial Agents
  • Cefazolin