Abstract
OBJECTIVE: To compare the efficacy of two antibiotic regimens (cefazolin vs clindamycin plus gentamicin) for preventing infectious complications after planned cesarean delivery. METHODS: A retrospective cohort study was conducted at a tertiary university-affiliated medical center between 2012 and 2023. All women undergoing planned cesarean delivery were included and divided into two groups: The standard regimen group (control) was treated with cefazolin, and the study group, consisting of women with reported severe penicillin allergies or cephalosporin allergies, was treated with a clindamycin plus gentamicin regimen. Maternal and neonatal outcomes were analyzed with multivariate logistic regression. The primary outcome was the need for inpatient antibiotic treatment; the secondary outcome was readmission for obstetric or gynecologic complications. RESULTS: During the study period, 145,883 deliveries occurred in our department, of which 17,693 (12.1%) were by planned cesarean deliveries. Among these, 10,588 women (94.1%) received cefazolin, and 658 women (5.9%) received clindamycin plus gentamicin. Infectious complications were less frequent in the control group. The need for inpatient antibiotic treatment was 5.9% in the cefazolin group compared with 15.2% in the clindamycin plus gentamicin group (P<.001), and readmission rates were 1.8% vs 3.8%, respectively (P=.001). On multivariate analysis, the alternative regimen group had significantly higher odds of requiring inpatient antibiotics after cesarean delivery (adjusted odds ratio [aOR] 2.1, 95% CI, 1.54-2.80, P<.001) and readmission (aOR 1.95, 95% CI, 1.19-3.18, P=.008). CONCLUSION: Cefazolin may be more effective than clindamycin plus gentamicin in preventing infectious complications after planned cesarean delivery. This study emphasizes the importance of careful assessment of β-lactam allergies to guide optimal antibiotic choices. For women allergic to standard regimens, alternative strategies should be considered to reduce postoperative infections and complications.