Cesarean prophylaxis: a comparison of cefamandole and cefazolin by both intravenous and lavage routes, and risk factors associated with endometritis

Article Abstract:

Women undergoing cesarean section may subsequently develop endometritis (infection of the uterine lining) or other infections, and antibiotics may be administered at the time of surgery to prevent this. Two antibiotic drugs of the cephalosporin class, cefazolin (an older, less expensive drug) and cefamandole, were compared for their ability to prevent infection in 207 women who underwent nonelective cesarean sections. Approximately three quarters of the patients had incomes below the federal poverty level and 83 percent were either Hispanic or non-Hispanic white. Patients were assigned to one of four groups: group 1, who received cefazolin intravenously (IV), beginning after the infant's umbilical cord was clamped, and saline via intraoperative lavage (a 'wash' of the wound and operated areas performed during surgery); group 2, cefamandole IV with saline intraoperative lavage; group 3, cefazolin by intraoperative lavage with saline IV; and group 4, cefamandole by intraoperative lavage with saline IV. Patients were monitored for the development of fever, tenderness, and infection. Results showed that there were no differences among the groups with respect to the incidence of endometritis, wound infection, or urinary tract infection. The groups were also similar with respect to preoperative and operative risk factors for the development of infection. Twenty-two women developed endometritis and, of these, eight had experienced surgical complications. Comparison of these patients with women experiencing complications who did not develop endometritis showed that certain complications increased the risk of this uterine infection. These were extension of the uterine incision, hemorrhage greater than 1.1 liters, or both. The two drugs appeared equivalent in their abilities to prevent infection; in addition, the two routes of administration (lavage and IV) did not affect the outcome. Thus, it appears that cefazolin, at approximately half the cost, is as effective as cefamandole in preventing infection after nonelective cesarean section. (Consumer Summary produced by Reliance Medical Information, Inc.)

Inflammation, Uterus, Cefamandole

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Bacterial vaginosis as a risk factor for post-cesarean endometritis

Article Abstract:

Postpartum endometritis (uterine infection developing after delivery) following cesarean section occurs in as many as 20 percent of patients; although certain factors are thought to be associated with it (such as frequent pelvic examinations prior to delivery and prolonged labor), questions remain regarding the role of other factors. It is possible that a large number of infectious organisms in the lower genital tract, such as occurs in bacterial vaginosis (vaginal infection due to agents such as Gardnerella vaginalis), could predispose patients to endometritis. To explore this notion, vaginal smears were obtained from all women who underwent speculum examinations (pelvic examinations in which the speculum was used) on admission to the Labor and Delivery unit of one hospital during a period of several years. The smears were evaluated as normal, or as representative of bacterial vaginosis, depending, in part, on the density of Gardnerella organisms. Medical records of patients who delivered by cesarean section were reviewed to establish the diagnosis of postpartum endometritis or amniotic fluid infection (the fluid in which the fetus floats), when appropriate. Results revealed that 21 percent of the 462 vaginal smears obtained in the study were classified as indicating bacterial vaginosis. Eight percent of the women developed amniotic fluid infection, and fifteen percent developed postpartum endometritis. Of the postpartum endometritis group, a significantly greater proportion had smears indicating bacterial vaginosis than normal smears. Other factors related to postpartum endometritis were maternal age less than 25 years; the number of hours that elapsed between membrane rupture and delivery; and bacterial vaginosis. The results indicate that bacterial vaginosis is a risk factor for the development of postpartum endometritis and amniotic fluid infection in women undergoing cesarean delivery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Vaginosis

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Antibiotic prophylaxis for cesarean delivery: is an extended-spectrum agent necessary?

Article Abstract:

Endometritis (inflammation or infection of the uterine lining) is the most common complication of cesarean section, but the frequency of its occurrence can be significantly reduced by the administration of an antibiotic at the time of surgery. The choice of the specific antibiotic varies, and physicians tend to prescribe newer, more expensive drugs even though evidence that they provide better protection is lacking. To learn more about this issue, 377 women who underwent nonelective (emergency) cesarean sections were given either cefazolin or cefotetan intravenously, immediately after the umbilical cord was clamped. After surgery, patients were observed for signs of fever, pelvic pain, uterine tenderness, or irritation. Other signs were also evaluated, including those associated with urinary tract infections. Although cefotetan had been predicted to be the more effective agent, the results showed no differences between the two groups in postoperative illness. Endometritis occurred in approximately one-fifth of the women, regardless of the antibiotic they had received. Urinary tract infections in 16 of 18 cases were due to enterococcus, which also caused the three cases of bacteremia (bacteria in the bloodstream). This organism is resistant to cephalosporins (the drug class to which both cefazolin and cefotetan belong) and was equally prevalent in both drug groups. Overall, the results do not support the belief that the newer, more expensive drug, cefotetan, is more effective than cefazolin in preventing endometritis after nonelective cesarean section. (Consumer Summary produced by Reliance Medical Information, Inc.)

Drug therapy, Cefotetan

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