{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T05:17:43Z","timestamp":1762060663751,"version":"build-2065373602"},"reference-count":29,"publisher":"Georg Thieme Verlag KG","issue":"S 01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:p>\n            Objective\u2003Our objective was to determine modifiable risk factors associated with surgical site infection (SSI) and postpartum endometritis. We hypothesized that inappropriate surgical antibiotic prophylaxis would be a risk factor for both types of infections.<\/jats:p><jats:p>\n            Study Design\u2003This was a single-center case-control study of SSI and endometritis after cesarean delivery over a 2-year period from 2016 to 2017. Cases were identified by International Classification of Diseases, 10th Revision diagnosis codes, infection control surveillance, and electronic medical records search and were subsequently confirmed by chart review. Three controls were randomly selected for each case from all cesareans\u2009\u00b1\u200948\u2009hours from case delivery. Demographic, pregnancy, and delivery characteristics were abstracted. Separate multivariable logistic regression models were used to assess factors associated with SSI and endometritis. Postpartum outcomes, including length of stay and readmission, were also compared.<\/jats:p><jats:p>\n            Results\u2003We identified 141 cases of SSI and endometritis with an overall postpartum infection rate of 4.0% among all cesarean deliveries. In adjusted analysis, factors associated with both SSI and endometritis were intrapartum delivery, classical or other (non\u2013low-transverse) uterine incision, and blood transfusion. Factors associated with SSI only included inadequate antibiotic prophylaxis, public insurance, hypertensive disorder of pregnancy, and nonchlorhexidine abdominal preparation; factors only associated with endometritis included \u03b2-lactam allergy, anticoagulation therapy, and chorioamnionitis. Among cases, 34% of those with SSI and 25% of those with endometritis did not receive adequate antibiotic prophylaxis, compared with 12.9 and 13.5% in control groups, respectively. Failure to receive appropriate antibiotic prophylaxis was associated with an increased risk of SSI (adjusted odds ratio [aOR]: 4.4, 95% confidence interval [CI]: 1.3\u201315.6) but not endometritis (aOR 0.9, 95% CI 0.4\u20132.0).<\/jats:p><jats:p>\n            Conclusion\u2003Inadequate surgical antibiotic prophylaxis was associated with an increased risk of SSI but not postpartum endometritis, highlighting the different mechanisms of these infections and the importance of prioritizing adequate surgical prophylaxis. Additional potentially modifiable factors which emerged included blood transfusion and chlorhexidine skin preparation.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/a-1904-9583","type":"journal-article","created":{"date-parts":[[2022,7,20]],"date-time":"2022-07-20T22:56:05Z","timestamp":1658357765000},"page":"e520-e527","source":"Crossref","is-referenced-by-count":2,"special_numbering":"S","title":["Perioperative Antibiotics and Other Factors Associated with Postcesarean Infections: A Case-Control Study"],"prefix":"10.1055","volume":"41","author":[{"given":"Cassandra R.","family":"Duffy","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Oberhardt","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York"},{"name":"NewYork-Presbyterian Value Institute, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naima","family":"Ross","sequence":"additional","affiliation":[{"name":"Columbia University Vagelos College of Physicians and Surgeons, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julie","family":"Ewing","sequence":"additional","affiliation":[{"name":"NewYork-Presbyterian Value Institute, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Messina","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Columbia University Irving Medical Center, New York, New York"},{"name":"Department of Infection Prevention and Control, New York-Presbyterian Hospital, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelly","family":"Fitzgerald","sequence":"additional","affiliation":[{"name":"Department of Quality and Patient Safety, New York-Presbyterian Hospital, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa","family":"Saiman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Columbia University Irving Medical Center, New York, New York"},{"name":"Department of Infection Prevention and Control, New York-Presbyterian Hospital, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dena","family":"Goffman","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York"},{"name":"Department of Quality and Patient Safety, New York-Presbyterian Hospital, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2022,12,5]]},"reference":[{"issue":"01","key":"ref1","first-page":"1","article-title":"Births: Final Data for 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Health"},{"issue":"12","key":"ref5","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1016\/j.ajic.2013.04.020","article-title":"Surgical site infection after cesarean section: implementing 3 changes to improve the quality of patient care","volume":"41","author":"S Corcoran","year":"2013","journal-title":"Am J Infect Control"},{"issue":"11","key":"ref6","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.1016\/j.ajic.2016.04.217","article-title":"Reduction and sustainability of cesarean section surgical site infection: an evidence-based, innovative, and multidisciplinary quality improvement intervention bundle program","volume":"44","author":"C D Hsu","year":"2016","journal-title":"Am J Infect Control"},{"issue":"08","key":"ref7","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1016\/j.ajic.2015.04.001","article-title":"A multifaceted prevention program to reduce infection after cesarean section: interventions assessed using an intensive postdischarge surveillance system","volume":"43","author":"W Ng","year":"2015","journal-title":"Am J Infect Control"},{"issue":"04","key":"ref8","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/j.ajic.2009.10.004","article-title":"Educational intervention, revised instrument sterilization methods, and comprehensive preoperative skin preparation protocol reduce cesarean section surgical site infections","volume":"38","author":"P N Rauk","year":"2010","journal-title":"Am J Infect Control"},{"issue":"09","key":"ref9","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1016\/j.ajic.2011.12.011","article-title":"Reduction of surgical site infections in low transverse cesarean section at a university hospital","volume":"40","author":"M M Riley","year":"2012","journal-title":"Am J Infect Control"},{"issue":"10","key":"ref10","doi-asserted-by":"crossref","first-page":"e73","DOI":"10.1016\/j.ajic.2011.05.001","article-title":"Effect of interventions in reducing the rate of infection 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Sullivan","year":"2007","journal-title":"Am J Obstet Gynecol"},{"issue":"07","key":"ref20","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1056\/NEJMoa1511048","article-title":"A randomized trial comparing skin antiseptic agents at cesarean delivery","volume":"374","author":"M G Tuuli","year":"2016","journal-title":"N Engl J Med"},{"issue":"08","key":"ref21","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1017\/ice.2015.116","article-title":"Practices to reduce surgical site infections among women undergoing cesarean section: a review","volume":"36","author":"R A McKibben","year":"2015","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"13","key":"ref22","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1056\/NEJMoa1602044","article-title":"Adjunctive azithromycin prophylaxis for cesarean delivery","volume":"375","author":"A T Tita","year":"2016","journal-title":"N Engl J 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