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Evaluation of Adjunctive Azithromycin Prophylaxis in Women Undergoing Cesarean Delivery in a Setting With Low Baseline Incidence of Surgical Site Infection

Published:January 04, 2021DOI:https://doi.org/10.1016/j.jogc.2020.12.016

      ABSTRACT

      Objective

      The purpose of this quality improvement study was to determine the effect of adding azithromycin to standard antibiotic prophylaxis on the rates surgical site infection (SSI) in women undergoing both elective and non-elective cesarean deliveries at our centre.

      Methods

      A before-and-after quality improvement study was conducted at the Regina General Hospital in Regina, Saskatchewan. Data collected from 989 women who had a caesarean delivery between June 1, 2016 and June 30, 2017 were compared with those from 1033 women who had a caesarean delivery between August 1, 2017 and July 31, 2018, after the introduction of adjunctive azithromycin prophylaxis. The primary outcome measure was the change in the incidence of SSI up to 30 days following surgery. Secondary outcome measures included timing of azithromycin prophylaxis and the number of women who did not receive azithromycin.

      Results

      Surgical site infection rates decreased from 3.5% to 2.9% after adjunctive azithromycin prophylaxis was introduced. The absolute reduction in SSIs of 0.6% was not statistically significant (P = 0.42). There were no differences in SSI rates between the elective and non-elective subgroups.

      Conclusion

      Adding azithromycin to the standard antibiotic prophylaxis for cesarean delivery showed no statistically significant reduction in SSI rates in a population with low baseline rates of SSI.

      RÉSUMÉ

      Objectif

      L'objectif de cette étude d'amélioration de la qualité était de déterminer l'effet de l'ajout d'azithromycine au protocole standard d'antibioprophylaxie sur le taux d'infection du champ opératoire (ICO) chez les femmes subissant une césarienne planifiée ou non planifiée dans notre centre de soins.

      Méthodologie

      Une étude sur l'amélioration de la qualité pré- et post-intervention a été menée à l'Hôpital général de Regina, en Saskatchewan. Les données recueillies de 989 femmes ayant subi une césarienne entre le 1er juin 2016 et le 30 juin 2017 ont été comparées à celles de 1 033 femmes ayant subi une césarienne entre le 1er août 2017 et le 31 juillet 2018, après l'instauration de la prophylaxie adjuvante par azithromycine. Le critère de jugement principal était la variation de l'incidence des ICO jusqu’à 30 jours après la césarienne. Les critères de jugement secondaires comprenaient le moment d'administration de la prophylaxie par azithromycine et le nombre de femmes qui n'ont pas reçu d'azithromycine.

      Résultats

      Les taux d'ICO sont passés de 3,5 à 2,9 % après l'instauration de la prophylaxie adjuvante par azithromycine. La réduction absolue de 0,6 % du taux d'ICO n’était pas statistiquement significative (P = 0,42). Aucune différence n'a été observée quant au taux d'ICO entre les sous-groupes de césarienne planifiée et de césarienne non planifiée.

      Conclusion

      L'ajout d'azithromycine au protocole standard d'antibioprophylaxie pour la césarienne n'a révélé aucune diminution statistiquement significative du taux d'ISO chez une population dont le taux initial d'ICO était faible.

      Keywords

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