The 2016 CSOAP trial showed azithromycin in addition to standard antibiotic (abx) prophylaxis (ppx) in unscheduled cesarean deliveries (CD) decreased post-operative infections. We compared rates of post-cesarean infections before and after adoption of adjunctive azithromycin for CDs. Retrospective cohort study of all singleton CDs (scheduled and unscheduled) at a single center. Deliveries were categorized as pre-CSOAP adoption (standard ppx only, 2013-Oct 2015) and post-CSOAP (standard ppx + azithromycin 500mg IV/1 hr, 2016-2018). CDs from Oct-Dec 2015 were excluded as a washout period. Abx were administered prior to skin incision. The primary outcome was a composite of post-CD infections up to 6 weeks postpartum (PP) confirmed by individual chart review (Table). Outcomes were compared between groups; multivariable analysis was used to compute adjusted odds ratios (95% CIs) with the pre-protocol group as reference. Of 6417 CDs in the study period, 3333 (52%) were post-CSOAP adoption. Baseline characteristics between groups were similar except more women post-protocol had A2DM and received abx for any infection (i.e. STI) 2 weeks prior to delivery (p<0.05). In crude and adjusted analyses, there was up to a 39% significant decreased odds of composite post-CD infection post-protocol (aOR 0.61 [0.48-0.78]), driven by a >40% decrease in wound infections (aOR 0.56 [0.43-0.78]). While there was no significant difference in endometritis or UTIs, there were significantly decreased overall wound complications (including non-infectious complications), PP abx receipt, PP fever and PP readmissions (Table). At our center, adjunctive azithromycin for all CDs (scheduled and unscheduled) resulted in significantly decreased odds of post-cesarean infections. These results support the widespread utility of adjunctive azithromycin and suggests that its routine use in all CDs should be considered the standard for obstetric care.