Division of Maternal and Fetal Medicine, Obstetrics and Gynecology Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio.
Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio.
Am J Perinatol. 2024 May;41(S 01):e2645-e2650. doi: 10.1055/a-2135-7084. Epub 2023 Jul 24.
Perioperative antibiotic prophylaxis reduces cesarean wound complications. This study investigates whether integration of standard-dose (500 mg) azithromycin prophylaxis reduced wound complications in patients with class III obesity (body mass index [BMI] ≥ 40 kg/m) undergoing unscheduled cesarean delivery.
Retrospective cohort study of patients with class III obesity undergoing unscheduled cesarean delivery in single hospital system from January 1, 2017, to January 1, 2020. A standard dose (500 mg) of azithromycin was integrated into system order sets in 2018. Medical history and postoperative wound outcomes were compared in pre- and postintegration cohorts. Wound complication was defined as composite of wound seroma, hematoma, superficial or deep infection.
A total of 1,273 patients met inclusion criteria, 303 patients in the preorder set group, and 970 patients in the postorder set group. Demographics were similar between the pre- and postintegration cohorts, including BMI (median: 44.4 kg/m, = 0.84) and weight at delivery (mean: 121.2 ± 17.8 kg, = 0.57). Patients in the postintegration cohort had lower rates of composite postpartum wound complication (7.9 vs. 13.9%, = 0.002), superficial infection or deep infection/abscess (6.7 vs. 10.2%, = 0.042), and postpartum readmission or unscheduled visits (18.7 vs. 24.4%, < 0.029). Rates of chorioamnionitis and endometritis were similar between the pre- and postintegration groups (8.6 vs. 6.9%, = 0.33, and 1.7 vs. 1.9%, = 0.81, respectively). Patients in the postintegration cohort had lower risk of postoperative composite wound complication (unadjusted odds ratio [OR]: 0.54, confidence interval [CI]: 0.36-0.80, = 0.002) and lower rates of wound infection (unadjusted OR: 0.63, 95% CI: 0.40-0.99, = 0.044). When comparing patients who received azithromycin at delivery and patients who did not, standard-dose azithromycin reduced risk of postoperative wound complication (unadjusted OR: 0.67, 95% CI: 0.46-0.99, = 0.043).
A standard dose of azithromycin provides adequate perioperative prophylaxis in class III obese patients, decreasing rates of postcesarean wound complications and unscheduled postpartum outpatient visits.
· Class III obese patients undergoing unscheduled cesarean have high rates of wound complications.. · Standard-dose azithromycin reduces risk of postcesarean wound infection in class III obese patients.. · Standard-dose azithromycin reduces readmission, unscheduled visits in class III obese patients..
围手术期预防性使用抗生素可降低剖宫产伤口并发症。本研究旨在调查标准剂量（500mg）阿奇霉素预防用药是否可降低 3 级肥胖（体重指数 [BMI]≥40kg/m）患者行择期剖宫产时的伤口并发症。
对 2017 年 1 月 1 日至 2020 年 1 月 1 日在单一医院系统中接受择期剖宫产的 3 级肥胖患者进行回顾性队列研究。2018 年，标准剂量（500mg）阿奇霉素被整合到系统医嘱中。比较了围手术期前、后队列的病史和术后伤口结局。将伤口血清肿、血肿、浅表或深部感染的复合症状定义为伤口并发症。
共有 1273 名患者符合纳入标准，其中 303 名患者在围手术期前组，970 名患者在围手术期后组。两组患者的人口统计学特征相似，包括 BMI（中位数：44.4kg/m， = 0.84）和分娩时体重（均值：121.2 ± 17.8kg， = 0.57）。围手术期后组患者的复合产后伤口并发症发生率较低（7.9% vs. 13.9%， = 0.002）、浅表感染或深部感染/脓肿（6.7% vs. 10.2%， = 0.042）和产后再入院或非计划门诊就诊率（18.7% vs. 24.4%， < 0.029）较低。围手术期前、后组的绒毛膜羊膜炎和子宫内膜炎发生率相似（8.6% vs. 6.9%， = 0.33 和 1.7% vs. 1.9%， = 0.81）。围手术期后组患者的术后复合伤口并发症风险较低（未调整优势比 [OR]：0.54，95%置信区间 [CI]：0.36-0.80， = 0.002）和伤口感染发生率较低（未调整 OR：0.63，95%CI：0.40-0.99， = 0.044）。与分娩时未使用阿奇霉素的患者相比，使用标准剂量阿奇霉素的患者术后伤口并发症风险较低（未调整 OR：0.67，95%CI：0.46-0.99， = 0.043）。
标准剂量阿奇霉素可为 3 级肥胖患者提供充分的围手术期预防用药，降低剖宫产术后伤口并发症和产后非计划门诊就诊率。
· 行择期剖宫产的 3 级肥胖患者伤口并发症发生率较高。· 标准剂量阿奇霉素可降低 3 级肥胖患者剖宫产术后伤口感染风险。· 标准剂量阿奇霉素可降低 3 级肥胖患者的再入院率和非计划门诊就诊率。
