Q: 32 year old patient is admitted to ICU with sepsis 48 hours after her cesarean section (C-section) surgery which was complicated by ruptured membranes. Reviewing the data you found that preoperative cefazolin was appropriately administrated 60 minutes prior to skin incision. Addition of which antibiotic may have prevented the sepsis?
Answer: Azithromycin
In patients with high-risk C-section i.e., intrapartum cesareans and cesareans with ruptured membranes (at least 4 hours after), the addition of azithromycin is recommended. This is found to reduce the composite outcome of endometritis, wound infection, or any other infection without impacting the frequency of adverse neonatal outcomes by 50 percent.
Ideally, in such situations an infectious-Disease (ID) consult is warranted.
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Reference:
1. Tita AT, Szychowski JM, Boggess K, et al. Adjunctive Azithromycin Prophylaxis for Cesarean Delivery. N Engl J Med 2016; 375:1231.
2. Tita ATN, Boggess K, Saade G. Adjunctive Azithromycin Prophylaxis for Cesarean Delivery. N Engl J Med 2017; 376:182.
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