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Open Access Research article

Ampicillin/Sulbactam versus Cefuroxime as antimicrobial prophylaxis for cesarean delivery: a randomized study

Eleftherios Ziogos1, Sotirios Tsiodras2, Ioannis Matalliotakis1, Helen Giamarellou2 and Kyriaki Kanellakopoulou2*

  • * Corresponding author: Kyriaki Kanellakopoulou kyrkanel@yahoo.gr

  • † Equal contributors

Author Affiliations

1 Department of Obtsterics and Gynecology, University General Hospital of Heraclion, Heracleion, Greece

2 4th Academic Department of Internal Medicine, University of Athens Medical School, Athens, Greece

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BMC Infectious Diseases 2010, 10:341  doi:10.1186/1471-2334-10-341

Published: 30 November 2010

Abstract

Background

The efficacy and safety of a single dose of ampicillin/sulbactam compared to a single dose of cefuroxime at cord clamp for prevention of post-cesarean infectious morbidity has not been assessed.

Methods

Women scheduled for cesarean delivery were randomized to receive a single dose of either 3 g of ampicillin-sulbactam or 1.5 g of cefuroxime intravenously, after umbilical cord clamping. An evaluation for development of postoperative infections and risk factor analysis was performed.

Results

One hundred and seventy-six patients (median age 28 yrs, IQR: 24-32) were enrolled in the study during the period July 2004 - July 2005. Eighty-five (48.3%) received cefuroxime prophylaxis and 91 (51.7%) ampicillin/sulbactam. Postoperative infection developed in 5 of 86 (5.9%) patients that received cefuroxime compared to 8 of 91 (8.8%) patients that received ampicillin/sulbactam (p = 0.6). In univariate analyses 6 or more vaginal examinations prior to the operation (p = 0.004), membrane rupture for more than 6 hours (p = 0.08) and blood loss greater than 500 ml (p = 0.018) were associated with developing a postoperative surgical site infection (SSI). In logistic regression having 6 or more vaginal examinations was the most significant risk factor for a postoperative SSI (OR 6.8, 95% CI: 1.4-33.4, p = 0.019). Regular prenatal follow-up was associated with a protective effect (OR 0.04, 95% CI: 0.005-0.36, p = 0.004).

Conclusions

Ampicillin/sulbactam was as safe and effective as cefuroxime when administered for the prevention of infections following cesarean delivery.

Trial registration

Clinicaltrials.gov identifier: NCT01138852