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TOPLINE:

In planned cesarean deliveries, cefazolin demonstrates superior infection prevention compared with clindamycin plus gentamicin, with significantly lower rates of inpatient antibiotic use (5.9% vs 15.2%) and readmissions (1.8% vs 3.8%).

METHODOLOGY:

• Researchers conducted a retrospective cohort study at a university-affiliated tertiary medical center between 2012 and 2023, including women undergoing planned cesarean delivery.
• Analysis included 11,246 eligible women with 10,588 receiving cefazolin (standard regimen) and 658 receiving clindamycin plus gentamicin (alternative regimen) because of severe penicillin or cephalosporin allergies.
• Prophylactic antibiotics were administered within 30 minutes before incision with cefazolin dosing at 2 g (3 g for women weighing ≥ 120 kg) and the alternative regimen consisting of clindamycin 600 mg plus gentamycin 5 mg/kg.
• Primary outcome measures included the need for inpatient antibiotic treatment, and secondary outcomes included readmission for obstetric or gynecologic complications.

TAKEAWAY:

• Infectious complications occurred less frequently in the cefazolin group with inpatient antibiotic treatment rates of 5.9% compared with 15.2% in the clindamycin plus gentamicin group (P < .001).
• Readmission rates were significantly lower in the cefazolin group at 1.8% vs 3.8% in the alternative regimen group (P = .001).
• Multivariate analysis revealed the alternative regimen group had higher odds of requiring inpatient antibiotics (adjusted odds ratio [aOR], 2.1; 95% CI, 1.54-2.80; P < .001) and readmission (aOR, 1.95; 95% CI, 1.19-3.18; P = .008).

IN PRACTICE:

“Cefazolin may be more effective than clindamycin plus gentamicin in preventing infectious complications after planned cesarean delivery. This study emphasizes the importance of careful assessment of β-lactam allergies to guide optimal antibiotic choices. For women allergic to standard regimens, alternative strategies should be considered to reduce postoperative infections and complications,” the authors of the study wrote.

SOURCE:

This study was led by Daniel Gabbai, MD, MPH, Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center in Tel Aviv, Israel, and published in O&G Open.

LIMITATIONS:

According to the authors, this study used indirect indicators of infectious complications rather than direct diagnoses of endometritis or surgical site infections. The retrospective design introduced potential selection bias, particularly due to missing data on prophylactic antibiotic use in some patients. The researchers noted that while major confounders were controlled for, unmeasured factors might have influenced the observed differences between antibiotic groups. Additionally, data on prenatal antibiotic use were not consistently available, and the 12-year study period at a single tertiary care center may limit the generalizability of findings to other institutions with different patient populations and care practices.

DISCLOSURES:

The authors reported no relevant conflicts of interest. This study was approved by the Tel Aviv Sourasky Medical Center Institutional Review Board (No. TLV-0284-08, July 10, 2024).

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.