Cefazolin proven effective in reducing post-cesarean infections

Cefazolin proven effective in reducing post-cesarean infections | Image Credit: © samrith - © samrith - stock.adobe.com.

Cefazolin may have greater efficacy for preventing infectious complications following planned cesarean delivery vs clindamycin plus gentamicin, according to a recent study published in O&G Open.

Approximately 29.7 cesarean delivery procedures per year are reported worldwide, with rates increasing over time. This has been linked to increasing maternal morbidity and mortality, highlighting cesarean birth as a public health concern. Puerperal infections are reduced using antibiotic prophylaxis, with first-generation cephalosporin recommended.

“However, for patients allergic to β-lactam agents, a single dose of clindamycin combined with an aminoglycoside is a reasonable alternative,” wrote investigators. “Nonetheless, ACOG has noted that this recommendation is based on limited available data.

Treatment groups and antibiotic regimens

The study was conducted to evaluate outcomes from cephalosporins vs alternative agents following cesarean delivery. Participants included women receiving planned cesarean delivery at a tertiary medical center from 2012 to 2023. Intrapartum or urgent cesarean deliveries were excluded from the analysis.

Patients receiving cefazolin as treatment were placed in the control group, while those treated with clindamycin plus gentamicin because of severe penicillin or cephalosporin allergies were placed in the study group. Doctors administered antibiotics within 30 minutes prior to incision, with 2 g of cefazolin considered the standard dose.

Clindamycin 600 mg and gentamycin 5 mg/kg were administered as the alternative regimen. The requirement for inpatient antibiotic therapy was reported as the primary outcome, while readmissions for obstetric complications and other related obstetric or gynecologic complications were reported as secondary outcomes.

Participant demographics and cesarean indications

Demographics, obstetric, and clinical characteristics were obtained from medical records. Investigators also collected data about pre-existing or gestational complications such as diabetes mellitus and preeclampsia and surgical variables such as skin closure technique and operative time.

There were 11,246 participants included in the final analysis, 94.1% of whom received cefazolin while 5.9% received clindamycin and gentamicin. Common indications for cesarean delivery included 2 or more prior cesarean births, malpresentation, a single cesarean delivery with patient request, and multiple pregnancy.

An older mean maternal age was reported in women receiving the alternative regimen, at 36.1±5.45 years, vs 35.1±5.24 years in the control group. These patients also had higher rates of assisted reproductive technology use, general anesthesia, and preeclampsia, at 28.2%, 5.1%, and 7.6%, respectively vs controls with rates of 23.2%, 2%, and 4.6%, respectively.

Clinical outcomes reveal higher risk with alternative regimen

Inpatient antibiotic use following cesarean delivery was reported in 6.4% of the study population, readmission for obstetric or gynecologic complications in 1.9%, and prolonged hospitalization in 7.5%. For the study group, rates were 15.2%, 3.8%, and 11.7%, respectively.

In the control group, the rates were 5.9%, 1.8%, and 7.2%, respectively. This highlighted significantly higher rates in the study group vs the control group. Additionally, packed red blood cell rates were 4.3% in the study group and 1.6% in the control group, indicating a greater risk from the alternative antibiotic regimen.

The alternative prophylactic antibiotic regimen was identified as an independent risk factor for each outcome following adjustments for covariates. Adjusted odds ratios for postcesarean antibiotic use, readmission for obstetric or gynecologic complications, and packed red blood cell transmissions were 2.1, 1.95, and 1.98, respectively.

Conclusion and recommendations

Overall, the data found increased efficacy from cefazolin toward reducing the rate of infectious complications vs clindamycin plus gentamicin following planned cesarean delivery. Investigators recommended further randomized controlled trials be conducted to determine the efficacy and cost-effectiveness of second-line antibiotics in mothers.

“These findings emphasize the importance of thorough allergy assessments and suggest the need for alternative strategies to improve outcomes in this population,” wrote investigators.

References

1. Gabbai D, Gilboa I, Lavie A, Yogev Y, Attali E. Comparing antibiotic regimens for preventing infections after planned cesarean delivery. O&G Open. 2025;2(4). doi:10.1097/og9.0000000000000108
2. Boerma T, Ronsmans C, Melesse DY, et al. Global epidemiology of use of and disparities in caesarean sections. Lancet. 2018;392:1341–8. doi:10.1016/S0140-6736(18)31928-7