Does Adjunctive Azithromycin Cesarean Bundle Decrease the Risk of Maternal and Neonatal Outcomes? [24H

Abstract

INTRODUCTION: The goal of preoperative antibiotics is to decrease and prevent postpartum infections. Recent evidence indicates that adding azithromycin (AZI) to Cefazolin as extended antibiotic coverage can decrease the risk of infectious co-morbidities for non-elective Cesarean Deliveries (nCD). November 2017 we started using AZI + cefazolin in nCD. The goal was to determine the institutional compliance to AZI administration. METHODS: An IRB approved retrospective cohort study over 4 months of patients undergoing nCD. ST (1st generation cephalosporin or, clindamycin and gentamycin for cephalosporin allergy). Patients in 2 groups: preEMR bundle (ST) and postEMR bundles (ST + AZI). Maternal and neonatal outcomes collected for 2 months preEMR bundle and 2 months postEMR bundles. Exclusion criteria: women undergoing elective CD, did not receive pre-operative antibiotics, AZI allergy. The primary outcome was overall compliance with AZI administration with the new EMR bundle. The composite outcome-maternal wound infection, endomyometritis, maternal morbidity, neonatal morbidity. Statistical analyses were performed with p value <0.05 significant. RESULTS: There were 100 patients meeting inclusion criteria in study time period. There were no differences in baseline demographics between groups. Only 56% of patients in the post EMR group received AZI in addition to ST. There were no significant differences in the composite outcome between groups. CONCLUSION: Adjunctive AZI at time of nCD does not appear to decrease the risk of maternal and neonatal outcomes; but it was only administered correctly in 56% of the eligible cases. The effect of AZI on outcomes may be improved with better adherence to the EMR bundle.