C Section & Antibiotics

[proman]

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What's the current recommendation for antibiotic prophylaxis for c/s? I've tried to find guidelines without much luck. The rate of surgical site infection or endomyometritis is fairly high for a "clean" procedure (6-14% by some sources).

The OBs here are doing cefazolin in the L&D room for elective or urgent c/s, to be completed within 30 min of incision (rarely timed appropriately). I gave a dose prior to incision on an elective c/s for fetal demise and quickly realized the OBs have no concept of tissue penetration or volume of distribution when they cut 30 seconds after I pushed the dose.

 

[militarymd]

 

[proman]

So that protocol had it 15 minutes prior to incision. What would you? Tell them not to cut until that time elapses? What if they want to cut at 2 minutes instead?

 

[militarymd]

doesn't matter..and its not a protocol...just a study looking at timing for abx

 

[Trisomy13]

Thanks for posting the study Mil. Now the question is, do the OB's at your hospital heed this study, or do they still ask for Abx at cord clamp? I plan on printing out the full article and floating it around our L&D floor to see the reactions. As a CA-1 I'd love to have one less thing to do right after the baby is out. I'm too busy watching the foley bag for gross hematuria 🙄 (well... this is OB dependent).

 

[gasnewby]

As a CA-1 I'd love to have one less thing to do right after the baby is out. I'm too busy watching the foley bag for gross hematuria 🙄 (well... this is OB dependent).

 

[Noyac]

One reason for giving abx at cord clamp is b/c babies that were exposed to abx's b/4 delivery (ie cord clamping) were required to undergo a sepsis workup. We give it early if there is no concern of sepsis in the baby, ie elective c/s. I never know what these OB folks are thinking so I just ask.

 

[militarymd]

Thanks for posting the study Mil. Now the question is, do the OB's at your hospital heed this study, or do they still ask for Abx at cord clamp? I plan on printing out the full article and floating it around our L&D floor to see the reactions. As a CA-1 I'd love to have one less thing to do right after the baby is out. I'm too busy watching the foley bag for gross hematuria 🙄 (well... this is OB dependent).

I'm in PP....we practice state of the art medicine ....crica 1982

 

[militarymd]

One reason for giving abx at cord clamp is b/c babies that were exposed to abx's b/4 delivery (ie cord clamping) were required to undergo a sepsis workup. We give it early if there is no concern of sepsis in the baby, ie elective c/s. I never know what these OB folks are thinking so I just ask.

neontal sepsis workups was one of the end points.

 

[Noyac]

neontal sepsis workups was one of the end points.

Exactly, they are showing no increased sepsis work-ups. What i was saying is that in the past, if the neonate was exposed to abx ten they would automatically do a sepsis work-up. This shows that it is not necessary or at least supports the belief.

PS: Is that a surrogate end-point?

 

[militarymd]

Exactly, they are showing no increased sepsis work-ups. What i was saying is that in the past, if the neonate was exposed to abx ten they would automatically do a sepsis work-up. This shows that it is not necessary or at least supports the belief.

PS: Is that a surrogate end-point?

yes

 

[coprolalia]

I agree. We always give cefazolin (or clindamycin in PCN allergics) at cord clamp. Not sure why we wait, because the levels getting to the baby are likely negligible and/or likely has no clinical impact on the newborn. So, timing should probably err on the "earlier" rather than "later" administration.

There is a lot that is done in OB care that is not evidence-based. Very hard to study this arena prospectively when so much is at stake.

-copro

 

[jwk]

Pretty much all our C/S antibiotics are given pre-op, either at the time an urgent C/S is called (if they have time) or after placing the epidural for a scheduled C/S. Most of them get a gram of cefazolin before incision.