Evaluating the Effect of an Antibiotic Prophylaxis Bundle on Surgical Site Infections After Cesarean Delivery in Women With Obesity: A Retrospective Cohort Study [ID 1295]

INTRODUCTION: Surgical site infections (SSIs) are a major cause of morbidity after cesarean, and women with obesity are at a higher risk for this complication. The aim of this study was to investigate the effect of expanded antibiotic prophylaxis on the rate of SSI after cesarean in women with obesity. The expanded prophylaxis bundle included postoperative cephalexin and metronidazole for patients with body mass index (BMI) greater than or equal to 30 as well as intraoperative azithromycin for patients in labor or with ruptured membranes. METHODS: We reviewed the records of patients with obesity who had a cesarean between 2015 and 2022 at a single academic medical center. We recorded demographics, prenatal and intrapartum factors affecting infection risk, antibiotic administration, and postoperative SSI. RESULTS: We analyzed 1,219 cesareans including 454 before implementation of the prophylaxis bundle and 765 afterward. The overall rate of SSI before the protocol was 6.2% compared to 6.4% after the protocol ( P =.90). There was no significant difference in SSI rates before and after the protocol when compared across BMI class, preterm versus term gestation, and ruptured versus unruptured membranes. CONCLUSIONS/IMPLICATIONS: In women with obesity who underwent cesarean, antibiotic prophylaxis with postoperative cephalexin and metronidazole, in addition to intraoperative azithromycin for those who had labored or ruptured membranes, did not reduce rates of SSI. Our findings suggest that these regimens should be reconsidered, perhaps particularly at medical centers with low baseline rates of SSI, to reduce unnecessary peripartum antibiotic exposure and the risk of emergence of antimicrobial resistance.