Incidence of Post-Cesarean Surgical Site Infection With Cefazolin Alone Versus Cefazolin Plus Azithromycin Prophylaxis: A Hospital-Based Observational Cohort Study
DOI:
https://doi.org/10.51168/fm8gys48Keywords:
cesarean delivery, surgical site infection, cefazolin, azithromycin, antibiotic prophylaxis, observational cohortAbstract
Background
Surgical site infection after cesarean delivery remains a significant cause of maternal morbidity, prolonged hospitalization, readmission, and increased treatment cost.
Objectives
To compare the 30-day cumulative incidence of post-cesarean surgical site infection between women receiving cefazolin alone and those receiving cefazolin plus azithromycin, and to identify clinical factors associated with infection.
Methods
This hospital-based observational cohort study was conducted at a tertiary care teaching hospital in Telangana, India. A total of 100 women undergoing cesarean delivery were enrolled and categorized according to prophylaxis received: cefazolin alone [n=50] or cefazolin plus azithromycin [n=50]. The primary outcome was surgical site infection within 30 days. Secondary outcomes included febrile morbidity, prolonged hospital stay, readmission due to infection, need for resuturing or drainage, and postoperative wound discharge. Demographic, obstetric, and perioperative variables were also assessed.
Results
Baseline demographic and obstetric characteristics were comparable between groups. During 30-day follow-up, 10 of 100 women developed surgical site infection, yielding a cumulative incidence of 10.0%. Infection occurred in 14.0% of the cefazolin-alone group and 6.0% of the combination group, with an absolute risk difference of 8.0 percentage points; however, the difference was not statistically significant [p=0.18]. Superficial incisional infection was the most frequent type [7.0%], followed by deep incisional infection [2.0%] and organ/space infection [1.0%]. Secondary infectious outcomes were consistently lower in the combination group. Surgical site infection was significantly associated with BMI ≥30 kg/m², rupture of membranes >12 hours, and operative duration >60 minutes.
Conclusion
Cefazolin plus azithromycin prophylaxis was associated with a lower 30-day risk of post-cesarean surgical site infection and fewer postoperative infectious complications than cefazolin alone. Although the difference was not statistically significant, the overall trend favored adjunctive azithromycin.
Recommendation
Larger multicenter prospective studies are recommended to validate these findings and guide prophylactic antibiotic strategies for high-risk cesarean deliveries.
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Copyright (c) 2026 Dr Vidyullatha Balivada, Dr Usharani Nagarapu, Dr Akula Swaroopa Rani, Dr Prashanth Kumar Patnaik (Author)
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