Saturday, January 28, 2017

Antibiotics After Cesarean Curb Infection in Obese Women


By www.medscape.com

LAS VEGAS — When obese women received a course of inexpensive antibiotics after cesarean delivery, surgical-site infections dropped by 60%, new research shows.

If this antibiotic strategy was implemented nationally, nearly 46,000 surgical-site infections and five maternal deaths would be prevented each year, at savings of more than $1 billion, investigators estimate.

"Even though the standard of care is to give antibiotics before the incision, in obese women, drug levels are lower," said lead investigator Carri Warshak, MD, associate professor of maternal–fetal medicine at the University of Cincinnati.

And with blood loss during cesarean delivery, "antibiotic blood levels are going to be even lower, and are basically gone by 4 hours after delivery," she told Medscape Medical News. At 4 hours, they're not healed and bacteria continue to get into the incision and uterus, especially in women with ruptured membranes."

Obese women make up a significant proportion of the 1.3 million annual cesarean deliveries. In fact, obesity complicates an estimated 30% to 40% of pregnancies, Dr Warshak reported.

An estimated 3% to 13% of all cesarean deliveries are complicated by surgical-site infections, and obese women are two to five times more likely to develop these infections.

High Risk for Infection

Here at the Society for Maternal-Fetal Medicine 2017 Annual Pregnancy Meeting, Dr Warshak presented results from a study that evaluated whether an extended course of antibiotics could reduce the rate of surgical-site infections in women with a body mass index (BMI) of at least 30 kg/m².

In the prospective, double-blind, randomized controlled trial, 192 women received cephalexin 500 mg plus metronidazole 500 mg administered orally every 8 hours for 48 hours and 190 received placebo.

The rate of tobacco use was high in both the antibiotic and placebo groups (27% vs 30%), as were rates of pregestational diabetes (16% vs 19%) and chronic hypertension (49% vs 51%). Average gestational age at delivery was 37.5 weeks in the two groups, and rates of multiples, primary cesarean, and pre-eclampsia were similar. All women received standard perioperative care, and the vast majority underwent low-transverse Pfannenstiel incision and suture skin closures.

The primary outcome was a surgical-site infection in the uterus or the incision. Secondary outcomes included any incision morbidity, cellulitis, endometritis, any fever, and wound separation.

Overall, the rate of surgical-site infection was 63% lower in the antibiotic group than in the placebo group. For the 119 women with ruptured membranes, it was 77% lower, and for the 264 women with intact membranes, it was 44% lower, although that difference was not significant. One woman included in this analysis had been excleded from the previous analysis because she no longer met the criteria for BMI.

Source: http://www.medscape.com/viewarticle/875067