dministration of cefazolin prior to skin incision is superior to efazolin at cord clamping in preventing postcesarean nfectious morbidity : a randomized , controlled trial

esarean delivery is the most commonly performed surgery in the nited States, with nearly 1.2 million rocedures performed in 2004. Infecious morbidity, consisting primarily of endomyometritis and wound infection, remains a leading cause of postoperative complications. Estimates of postcesarean infection rates range from 7% to 20%, depending on demographic and obstetric variables. Infection following cesarean delivery results in not only increased hospital stay but also increases the cost of care. For example, diagnosing and treating a single case of endometritis is estimated to cost $815. Prophylactic antibiotics can reduce the incidence of postcesarean infectious morbidity by as much as 75%. This risk reduction is observed in both planned and emergent cesareans. First-generation cephalosporin antibiotics are the most commonly used agents and are usually administered following delivery of the infant after the cord is clamped. Neither the use of broad-spectrum antimicrobials nor the administration of additional doses postoperatively has been shown to be superior to a single-dose Optimal timing for prophylactic antibiotic administration is based on animal studies that demonstrate a maximum protective effect when adequate tissue antibiotic levels are present prior to bacterial contamination. However, concerns about neonatal exposure to antibiotics and the potential effect on a neonatal sepsis workup prompted obstetricians to delay the administration until the time of umbilical cord clamping. In addition, there is concern regarding the potential selection of resistant pathogens, especially Escherichia coli. There is no prospective evidence to support these concerns. A recent randomized trial found no difference in neonatal sepsis, sepsis workups, or neonatal intensive care unit (NICU) admissions between groups administered prophylactic antibiotics preoperatively or at cord clamping. In the majority of surgical procedures that require prophylaxis, antibiotics are usually administered prior to the skin incision. Delay in administration has rom the Departments of bstetrics/Gynecology (Drs Sullivan, Smith, hang, Vandorsten, and Soper) and iostatistics, Bioinformatics, and pidemiology (Dr Hulsey), Medical niversity of South Carolina, Charleston, C 29425. resented at the 27th Annual Clinical Meeting f the Society for Maternal-Fetal Medicine, an Francisco, CA, Feb. 5-10, 2007. eceived Dec. 8, 2006; revised Jan. 25, 007; accepted Mar. 5, 2007. eprints: Scott A Sullivan, MD, Medical niversity of South Carolina, 96 Jonathan ucas Street, Charleston, SC 29425; ullivas@musc.edu. upported by the Department of Obstetrics nd Gynecology Research Foundation, edical University of South Carolina. 002-9378/$32.0