What is the treatment for a cesarean section (C-section) wound infection?

Treatment of C-Section Wound Infection

For C-section wound infection, first-line treatment should be cefazolin (with or without metronidazole) for mild to moderate infections, while severe infections require broader coverage with vancomycin plus piperacillin-tazobactam or a carbapenem. 1

Initial Assessment and Classification

• Determine severity of infection based on:
  • Extent of erythema and induration (>5 cm from wound edge suggests more severe infection)
  • Presence of systemic symptoms (fever, tachycardia)
  • Hemodynamic stability
  • Mental status changes

Treatment Algorithm

1. Mild to Moderate Infection (Outpatient Management)

• First-line antibiotic therapy:

  • Cefazolin 1-2g IV every 8 hours or
  • Cephalexin 500 mg orally every 6 hours 1
  • Add metronidazole 500 mg every 8 hours if anaerobic coverage needed 1

• Alternative options (for penicillin allergy):

  • Clindamycin 300-450 mg orally every 6 hours 1, 2

2. Severe Infection (Inpatient Management)

• Broad-spectrum coverage required:

  • Vancomycin 15 mg/kg IV every 12 hours plus
  • Piperacillin-tazobactam 3.375g IV every 6 hours or 4.5g every 8 hours OR
  • A carbapenem (e.g., meropenem 1g every 8 hours) 1

• Consider MRSA coverage if:

  • High local MRSA prevalence
  • Patient has risk factors for MRSA
  • No response to initial therapy 3

Wound Management

1. Incision and drainage of any purulent collections is essential 1

   • Surgical site infections require suture removal plus incision and drainage 1

2. Wound cleansing and irrigation:

   • Use tap water or sterile saline (avoid antiseptic agents like povidone-iodine) 1
   • Ensure thorough cleaning to properly visualize extent of infection 3

3. Wound culture:

   • Obtain wound culture before starting antibiotics if purulent drainage is present 3
   • This helps guide targeted antibiotic therapy if initial empiric treatment fails

4. Wound dressing:

   • Cover with occlusive dressing to promote healing 1
   • Change dressing regularly to monitor wound progress

Duration of Treatment

• Uncomplicated infections: 5-10 days
• Complicated infections: 10-14 days
• Reassess after 48-72 hours to ensure proper healing 3

Common Pathogens

C-section wound infections are typically caused by:

• Skin flora (Staphylococcus aureus, Staphylococcus epidermidis)
• Vaginal flora (Streptococcus species, Enterobacteriaceae, anaerobes)
• Occasionally MRSA 4, 5

Prevention of Recurrence

• Identify and treat predisposing conditions (obesity, diabetes, immunosuppression) 1
• Ensure proper wound care technique
• Consider prophylactic antibiotics for patients with multiple recurrent infections 1

Important Caveats

• Avoid antibiotic overuse: Simple abscesses that are adequately drained may not require antibiotics 3
• Don't miss deep infections: Prompt surgical consultation is needed for aggressive infections with signs of systemic toxicity 1
• Monitor for treatment failure: If no improvement after 48-72 hours, reassess and consider broadening antibiotic coverage or surgical intervention
• Consider patient-specific factors: Diabetes, obesity, and immunosuppression may require more aggressive management and longer treatment duration

The evidence strongly supports the use of cefazolin as first-line therapy for surgical site infections, with broader coverage for more severe infections. Proper wound care with thorough cleaning and drainage of purulent collections is essential for successful treatment.