Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2015 May;125(5):1205-1210.
doi: 10.1097/AOG.0000000000000789.

Cefazolin prophylaxis in obese women undergoing cesarean delivery: a randomized controlled trial

Lindsay Maggio  1 , David P Nicolau, Melissa DaCosta, Dwight J Rouse, Brenna L Hughes
Affiliations
Randomized Controlled Trial

Cefazolin prophylaxis in obese women undergoing cesarean delivery: a randomized controlled trial

Lindsay Maggio et al. Obstet Gynecol. 2015 May.

Abstract

Objective: To compare adipose tissue concentration among obese women receiving 2 g compared with 3 g of precesarean cefazolin prophylaxis.

Methods: This was a double-blind randomized controlled trial of women with singleton gestations and body mass indexes (BMIs) of 30 or greater at their first prenatal visit undergoing cesarean delivery at term. Women were randomly allocated, stratified by BMI, to receive 2 g or 3 g of cefazolin. Subcutaneous adipose tissue was harvested twice: before (opening) fascial incision and after (closing) fascial closure. The primary outcome was opening adipose tissue cefazolin concentration, measured by high-pressure liquid chromatography.

Results: From April 2013 to July 2014, 58 women were enrolled, 57 included in the analysis: 28 in the 2-g group and 29 in the 3-g group. Baseline characteristics were similar between groups. Median opening adipose tissue concentration was similar between the 2-g and 3-g groups (9.4 [interquartile range 5.1-13.4] compared with 11.7 [interquartile range 7-18.3] micrograms/g, P=.12). The percentage of women with opening concentrations above 8 micrograms/g, the minimally inhibitory concentration of cefazolin for Staphylococcus species, was similar (61% compared with 72%, P=.35). All samples were above 2 micrograms/g, the minimally inhibitory concentration for Enterobacteriaceae. Closing adipose tissue concentrations and stratified analyses were consistent with the overall analysis.

Conclusion: In obese women undergoing cesarean delivery, prophylaxis with 3 g of cefazolin did not significantly increase adipose tissue concentration. Thus, our data do not support recommendations for 3-g dosing.

Level of evidence: I.

Trial registration: ClinicalTrials.gov NCT01810354.

PubMed Disclaimer

References

    1. Toma O, Suntrup P, Stefanescu A, London A, Mutch M, Kharasch E. Pharmacokinetics and tissue penetration of cefoxitin in obesity: implications for risk of surgical site infection. Anesth Analg 2011;113:730–7.
    1. Anderson DJ, Kaye KS, Classen D, Arias KM, Podgorny K, Burstin H, et al.. Strategies to prevent surgical site infections in acute care hospitals. Infect Control Hosp Epidemiol 2008;29(suppl 1):S51–61.
    1. Tita AT, Rouse DJ, Blackwell S, Saade GR, Spong CY, Andrews WW. Emerging concepts in antibiotic prophylaxis for cesarean delivery: a systematic review. Obstet Gynecol 2009;113:675–82.
    1. Martin JA, Hamilton BE, Ventura SJ, Osterman MJ, Mathews TJ. Births: final data for 2011. Natl Vital Stat Rep 2013;62:1–69, 72.
    1. Dinsmoor MJ, Gilbert S, Landon MB, Rouse DJ, Spong CY, Varner MW, et al.. Perioperative antibiotic prophylaxis for nonlaboring cesarean delivery. Obstet Gynecol 2009;114:752–6.

Publication types

Associated data