From the Guidelines
Prophylaxis against surgical site infections (SSI) in cesarean deliveries requires a comprehensive approach including preoperative antibiotics, proper skin preparation, and other preventive measures, with the cornerstone being administering a single dose of antibiotics 30-60 minutes before skin incision, as recommended by the most recent and highest quality study 1.
Key Elements of Prophylaxis
- Administering a single dose of antibiotics 30-60 minutes before skin incision, with a first-generation cephalosporin being the preferred agent, as supported by high-quality evidence 1
- Vaginal preparation with povidone-iodine immediately before cesarean delivery reduces infection risk, particularly in women with ruptured membranes, as noted in the guidelines for intraoperative care in cesarean delivery 1
- Chlorhexidine-alcohol is preferred over povidone-iodine for skin antisepsis due to superior antimicrobial activity, as recommended by the Enhanced Recovery After Surgery Society guidelines 1
- Hair removal, if necessary, should be done with clippers rather than razors to minimize skin trauma, as suggested by the principles of surgical site infection control and prevention 1
Additional Considerations
- Maintaining normothermia and glycemic control are important physiological factors that reduce infection risk, as emphasized in the guidelines for perioperative care in elective abdominal and pelvic surgery 1
- For women with obesity, higher antibiotic doses and meticulous attention to skin fold management are essential, as highlighted in the recommendations for intraoperative care in cesarean delivery 1
- Extended antibiotic prophylaxis beyond the initial dose is not recommended for routine cases but may be considered for high-risk situations, as noted in the guidelines for intraoperative care in cesarean delivery 1
From the FDA Drug Label
To prevent postoperative infection in contaminated or potentially contaminated surgery, recommended doses are: 1 gram IV or IM administered 1/2 hour to 1 hour prior to the start of surgery. For lengthy operative procedures (e.g., 2 hours or more), 500 mg to 1 gram IV or IM during surgery (administration modified depending on the duration of the operative procedure). 500 mg to 1 gram IV or IM every 6 to 8 hours for 24 hours postoperatively The elements of prophylaxis against SSI in cesarean deliveries are:
- Timing: 1 gram IV or IM administered 1/2 hour to 1 hour prior to the start of surgery
- Dose: 1 gram IV or IM
- Redosing: 500 mg to 1 gram IV or IM during surgery for lengthy operative procedures, and 500 mg to 1 gram IV or IM every 6 to 8 hours for 24 hours postoperatively 2
From the Research
Elements of Prophylaxis Against SSI in Cesarean Deliveries
The elements of prophylaxis against Surgical Site Infections (SSIs) in cesarean deliveries include:
- The use of prophylactic antibiotics, such as cefazolin, to reduce SSI rates 3, 4, 5
- The selection of prophylactic antibiotic agents based on effectiveness, safety, costs, and microbiological results 3
- The administration of antibiotics in the preoperative phase to prevent SSIs 3
- The use of cefazolin as a first-line antibiotic for surgical prophylaxis, even in penicillin-allergic patients, due to its safety and effectiveness 4, 6
- The avoidance of inappropriate alternative antibiotics, such as clindamycin only, which are associated with increased odds of SSIs 5
Antibiotic Regimens
The choice of antibiotic regimen is crucial in preventing SSIs in cesarean deliveries. The following regimens have been studied:
- Cefazolin: associated with lower odds of postpartum infectious morbidity, including SSIs 4, 5
- Clindamycin or metronidazole: associated with higher odds of postpartum infectious morbidity, including SSIs 4
- Vancomycin: associated with higher SSI rates, possibly due to inadequate dosage 7
Patient Factors
Patient factors, such as penicillin allergy, must be considered when selecting a prophylactic antibiotic regimen. Studies have shown that: