Homing In on Risk for Postcesarean Surgical Infection

Cesarean delivery is associated with higher postoperative infection rates than other major operations such as hysterectomy, but what determines this elevated risk? Investigators conducted a secondary analysis of a trial of antibiotic prophylaxis for nonelective cesarean delivery (NEJM JW Womens Health Nov 2016 and N Engl J Med 2016; 375:1231) in which 2013 women had been randomized to an intravenous bolus of cefazolin plus placebo or cefazolin plus azithromycin (500 mg) prior to surgical incision. In all, 8.8% of women developed postcesarean infection (defined as a composite of endometritis, superficial or deep wound infection, abscess, or sepsis occurring up to 6 weeks postpartum).

Factors associated with excess risk for postcesarean infect…