Abstract
Background The most common complication after cesarean delivery is surgical site infection. Antibiotic prophylaxis reduces infectious morbidity and current anesthetic quality metrics include preincision antibiotic prophylaxis. Recently, studies suggest reductions in infectious morbidity with the addition of azithromycin for unscheduled cesarean delivery. Larger doses of cefazolin are recommended for morbidly obese women, but evidence is conflicting. The aim of this study was to survey anesthesiologists to assess current practice for antibiotic prophylaxis for cesarean delivery. Methods We invited a random sample of 10,000 current members of the American Society of Anesthesiologists to complete an online survey about their current practice of antibiotic prophylaxis for cesarean delivery in November 2017. The survey included questions similar to a previous survey on this topic in 2012. Results The response rate was 12.2% (n = 1223). Most respondents had at least 15 years of experience (684, 55.9%), work at a nonteaching or community hospital (729, 59.6%), with >500 cesarean deliveries annually (619, 50.6%), and administer obstetric anesthesia several times a week (690, 56.4%). Routine preincision antibiotic prophylaxis was reported by 1162 (95.0%) of the 1223 respondents, a substantial improvement versus the 63.5% reported in the previous study in 2012. For intrapartum cesarean deliveries, 141 (11.5%) administer azithromycin for unscheduled cesarean deliveries. Those who use cefazolin, 509 (42.5%) administer 3 g for morbidly obese women. Conclusion Adherence to preincision antibiotic prophylaxis for cesarean delivery is very high, a significant improvement within 5 years. A minority of anesthesiologists utilize azithromycin for intrapartum cesarean deliveries. The dose of cefazolin for morbidly obese women varies widely.
Highlights
Cesarean delivery is a major risk factor for postpartum infection with a five to twenty times greater incidence as compared to vaginal delivery [1]
Routine preincision antibiotic prophylaxis rates were significantly improved from the 63.5% reported in the previous survey in 2012 (Χ2 (1) 356.4, P < 0.0001)
More evidence surfaced demonstrating significant reduction in postoperative infectious morbidity with preincision compared to postdelivery antibiotic administration, as well as the introduction of adherence to this policy as a quality metric in anesthesia [7, 8]. ere is significant variability in practice patterns across provider volume and experience, institutional volume, and region of the United States
Summary
Cesarean delivery is a major risk factor for postpartum infection with a five to twenty times greater incidence as compared to vaginal delivery [1]. Prophylactic antibiotics at the time of scheduled cesarean delivery have been shown to reduce the risk of wound infection (RR 0.62, 95% CI 0.47–0.82) and endometritis (RR 0.38, 95% CI 0.24–0.61) compared to placebo or no treatment [1]. In women without significant allergies, a single dose of a first-generation cephalosporin is recommended due to its efficacy, narrow spectrum of activity, and low cost [5]. In women with type 1 hypersensitivity to penicillins or cephalosporins, clindamycin plus an aminoglycoside is recommended [4]
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