Comparing Antibiotic Regimens for Preventing Infections After Planned Cesarean Delivery

To compare the efficacy of two antibiotic regimens (cefazolin vs clindamycin plus gentamicin) for preventing infectious complications after planned cesarean delivery.

A retrospective cohort study was conducted at a tertiary university-affiliated medical center between 2012 and 2023. All women undergoing planned cesarean delivery were included and divided into two groups: The standard regimen group (control) was treated with cefazolin, and the study group, consisting of women with reported severe penicillin allergies or cephalosporin allergies, was treated with a clindamycin plus gentamicin regimen. Maternal and neonatal outcomes were analyzed with multivariate logistic regression. The primary outcome was the need for inpatient antibiotic treatment; the secondary outcome was readmission for obstetric or gynecologic complications.

During the study period, 145,883 deliveries occurred in our department, of which 17,693 (12.1%) were by planned cesarean deliveries. Among these, 10,588 women (94.1%) received cefazolin, and 658 women (5.9%) received clindamycin plus gentamicin. Infectious complications were less frequent in the control group. The need for inpatient antibiotic treatment was 5.9% in the cefazolin group compared with 15.2% in the clindamycin plus gentamicin group (P<.001), and readmission rates were 1.8% vs 3.8%, respectively (P=.001). On multivariate analysis, the alternative regimen group had significantly higher odds of requiring inpatient antibiotics after cesarean delivery (adjusted odds ratio [aOR] 2.1, 95% CI, 1.54-2.80, P<.001) and readmission (aOR 1.95, 95% CI, 1.19-3.18, P=.008).

Cefazolin may be more effective than clindamycin plus gentamicin in preventing infectious complications after planned cesarean delivery. This study emphasizes the importance of careful assessment of β-lactam allergies to guide optimal antibiotic choices. For women allergic to standard regimens, alternative strategies should be considered to reduce postoperative infections and complications.