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Selective effect of cefoxitin prophylaxis on post-cesarean-section microbial flora.
M A Ismail1, K E Nelson, P Larson
1Department of Medicine, University of Illinois College of Medicine, Chicago.
The Journal of Reproductive Medicine
|February 1, 1990
Summary
Cefoxitin prophylaxis after cesarean section reduced infections but increased enterococcal overgrowth. The risk of enterococcal superinfection must be weighed against benefits when considering routine antibiotic use.
Area of Science:
- Obstetrics and Gynecology
- Infectious Diseases
- Pharmacology
Background:
- Post-cesarean section infections pose significant risks to maternal health.
- Antibiotic prophylaxis is a common strategy to prevent surgical site infections.
Purpose of the Study:
- To evaluate the efficacy of cefoxitin in preventing post-cesarean section infections.
- To assess the impact of cefoxitin prophylaxis on microbial flora and potential side effects.
Main Methods:
- A double-blind study involving three 2-g doses of cefoxitin administered post-cesarean section.
- Monitoring of patient morbidity, hospital stay, and microbial cultures (endocervix and stool).
Main Results:
- Cefoxitin significantly reduced infection-related morbidity and hospital stay.
- A reduction in anaerobic endocervical flora was observed.
- Increased overgrowth of enterococci was noted in nearly half of patients, leading to sepsis or urinary tract infections in some.
- No cefoxitin-resistant Enterobacteriaceae were detected.
Conclusions:
- Cefoxitin is effective in reducing post-cesarean section infection morbidity.
- Routine cefoxitin prophylaxis carries a risk of enterococcal colonization and superinfection.
- The benefits of cefoxitin must be balanced against the risks of enterococcal overgrowth.