48-Hours of Antibiotics Reduced Infection Rate After C-Section in Obese Women

MedicalResearch.com Interview with:

Dr. Carri R. Warshak, MD Associate Professor of Obstetrics & Gynecology University of Cincinnati

Dr. Warshak

Dr. Carri R. Warshak, MD
Associate Professor of Obstetrics & Gynecology
University of Cincinnati

MedicalResearch.com: What is the background for this study?

Response: Cesarean deliveries are the most common major surgical procedure performed in the United States. A common complication of cesarean section is wound infections that can include infections in the skin and incision site, or infections in the uterus itself after delivery. These complications can lead to prolonged hospitalization after delivery for antibiotics and even further surgery in severe infections. Often these wound complications lead to delayed healing, wound opening which can sometimes take several weeks to heal. Studies have demonstrated as many as 12% of women experience a surgical site infection after delivery.

Obesity is a strong risk factor for increased surgical site infections. Increasing maternal weight increases the risk of wound complications, with a two to five fold increase in risk, making surgical site infections and common and concerning complication of cesarean delivery in obese women.

MedicalResearch.com: What are the main findings?

Response: We compared a 48-hour course of antibiotics (metronidazole and cephalexin) after delivery to placebo.

We found in women who were obese and underwent cesarean delivery we could reduce the risk of surgical site infections from 15.4% in those who received placebo to 6.4% in those receiving antibiotics

MedicalResearch.com: What should clinicians and patients take away from your report?

Response: Infectious complications after major surgery, like cesarean delivery, can be reduced. We found that a 48 hour course of antibiotics was effective at reducing these common and serious complications in obese women who underwent cesarean delivery. We found a 60% reduction when women received antibiotics. We would prevent one surgical site infection for every 12 treated.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: I believe our study indicates the ability to make changes to improve outcomes following cesarean delivery. We targeted obese women because their rate of infection is considerably higher. There are many reasons obese women are at risk- changes in their immune system, decreased tissue blood perfusion, other morbidities like hypertension and diabetes, to name a few. There is still a lot to learn about why obese women have more infectious complications after surgery, and this information could lead to better prevention and treatment strategies.

In addition, although we have made strides with reducing the risk of infection after cesarean delivery with interventions like pre-operative antibiotics, skin preparations, pre-surgery showers and operative techniques, there are likely additional methods to prevent surgical site infections to be elucidated.

 

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Citation:

Valent AM, DeArmond C, Houston JM, Reddy S, Masters HR, Gold A, Boldt M, DeFranco E, Evans AT, Warshak CR. Effect of Post–Cesarean Delivery Oral Cephalexin and Metronidazole on Surgical Site Infection Among Obese WomenA Randomized Clinical Trial. JAMA. 2017;318(11):1026–1034. doi:10.1001/jama.2017.10567

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