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Cefazolin dosing in maternal obesity: A retrospective analysis
Abstract Number: T2A-3
Abstract Type: Original Research
Introduction: Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery recommends patients weighing ≥120kg receive 3g Cefazolin IV, however ACOG has been unable to establish guidelines for cesarean delivery due to lack of clinical evidence.(1,2,3) Despite some centers adhering to the latter guideline and administering 3g Cefazolin for cesarean delivery if maternal weight is ≥120kg, recent studies have not observed significant differences in surgical site infections.(2,3,5)
Methods: We conducted a retrospective review to compare infectious complications in parturients weighing ≥120kg who prophylactically received 2g vs 3g of Cefazolin for cesarean delivery.(6) Categorical variables between the antibiotic groups were assessed with χ2 tests. Continuous variables between the antibiotic groups were assessed with the Wilcoxon rank-sum test. P values <.05 were taken to signify statistical significance.
Results: In this study of 338 consecutive parturients undergoing cesarean delivery, there were no statistically significant differences in demographics between the two antibiotic groups. The postoperative wound infection rate was 9% vs. 6% for the 2g vs. 3g Cefazolin dose, respectively, however this did not reach statistical significance (p=0.2987). Gestation and associated obstetrical settings were not statistically significant between the two antibiotic groups other than type of skin closure. We observed a statistically significant difference in the incidence of postoperative infection based upon the dosage of Cefazolin when analyzed by skin closure technique (Table 1). The relative risk for postoperative infection in the 2g IV Cefazolin dose group with staple closure when compared to suture closure was 3.7 (CI 1.4-9.5; with a number needed to harm of 1 in 7 parturients) with this closure technique.
Discussion: In this study of antibiotic administration in parturients undergoing cesarean delivery, we observed a statistically significant association of postoperative infection with skin staple closure with 2g IV Cefazolin administration. These results suggest a higher dose of Cefazolin should be utilized during skin closure with staples.
1. Swank 2015
2. Ahmadzia 2015
3. ACOG 2015
4. Young 2015
5. Maggio 2015
6. Tita 2016