What antibiotic is recommended post cesarean section (C-section) for a patient with suspected placenta accreta spectrum (placenta accreta spectrum) who underwent prolonged instrumentation?

From the Guidelines

Cefazolin is the recommended antibiotic post cesarean section (C-section) for a patient with suspected placenta accreta spectrum who underwent prolonged instrumentation.

Rationale

• The patient is at an increased risk of postoperative infection due to prolonged instrumentation and suspected placenta accreta spectrum, making antibiotic prophylaxis crucial 1.
• A first-generation cephalosporin, such as cefazolin, is recommended for routine administration within 60 minutes before the cesarean delivery skin incision, as it provides effective coverage against common skin flora and other potential pathogens 1.
• The recommended dose of cefazolin is 2g, which can be administered intravenously 1.
• In cases of penicillin allergy, alternative antibiotics such as gentamicin and clindamycin can be considered, with doses of 5 mg/kg and 900 mg, respectively 1.
• The choice of antibiotic should take into account the type of surgical procedure, probable causative pathogens, and their resistance patterns, as emphasized by the Working Group considerations 1.

From the Research

Antibiotic Recommendations for C-Section with Placenta Accreta Spectrum

• The recommended antibiotic for a patient with suspected placenta accreta spectrum who underwent prolonged instrumentation post C-section is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
• However, the studies suggest that prophylactic antibiotics can reduce the incidence of postpartum infection in women undergoing C-section 2, 3, 4, 5, 6.
• The choice of antibiotic regimen may depend on various factors, including the type of C-section, the presence of other medical conditions, and the risk of antibiotic resistance 2, 3, 4, 5, 6.
• Some studies suggest that broad-spectrum antibiotics, such as cephalosporins, may be effective in reducing postoperative infections 2, 3, 4, 5.
• Others suggest that a single dose of antibiotic prophylaxis may be as effective as multiple doses in preventing postoperative infectious morbidity 6.

Comparison of Antibiotic Regimens

• A study comparing antistaphylococcal cephalosporins (1st and 2nd generation) versus broad-spectrum penicillins plus beta-lactamase inhibitors found that the two regimens may have similar efficacy in preventing postoperative infections 2.
• Another study found that ampicillin and first-generation cephalosporins have similar efficacy in reducing postoperative endometritis 3.
• A review of 95 studies found that prophylactic antibiotics reduced the incidence of wound infection, endometritis, and serious maternal infectious complications by 60% to 70% compared to placebo or no treatment 4.

Timing of Antibiotic Administration

• Some studies suggest that administering antibiotics before skin incision may be more effective than administering them after cord clamping 5.
• However, other studies found that the timing of antibiotic administration did not significantly affect the incidence of postoperative infections 3, 4.