Comparison of Cesarean Surgical Site Infection in Patients Treated with Cefazolin and Cefazolin Azithromycin Regimen

Abstract

Background:
Surgical site infection (SSI) is a common postoperative complication following caesarean section and remains a significant cause of maternal morbidity, prolonged hospital stay, and increased healthcare costs. Although cefazolin is widely used for antibiotic prophylaxis, its limited antimicrobial spectrum may be insufficient against polymicrobial organisms implicated in post-caesarean infections. Recent evidence suggests that adjunctive azithromycin may enhance prophylactic efficacy.

Objective:
To compare the incidence of surgical site infection among women undergoing caesarean section who received cefazolin alone versus those who received a combined cefazolin–azithromycin prophylactic regimen.

Methods:
A comparative observational study was conducted at a tertiary-care hospital over a 12-month period. A total of 200 women undergoing elective or emergency caesarean section were included and divided into two equal groups. Group A (n = 100) received intravenous cefazolin, while Group B (n = 100) received intravenous cefazolin plus azithromycin prior to skin incision. Participants were followed for 30 days postoperatively. Surgical site infection was diagnosed and classified according to standard CDC criteria. Data were analysed using SPSS version 26, with a p-value < 0.05 considered statistically significant.

Results:
The overall incidence of surgical site infection was 10%. SSI occurred in 14% of patients in the cefazolin group compared with 6% in the cefazolin–azithromycin group, demonstrating a statistically significant reduction in infection rates with combination prophylaxis (p = 0.03). Superficial incisional infection was the most common SSI subtype in both groups, while deep incisional infections were fewer in the combination group. Emergency caesarean section, maternal obesity, prolonged labour, prolonged rupture of membranes, and longer surgical duration were significantly associated with higher SSI risk.

Conclusion:
The addition of azithromycin to standard cefazolin prophylaxis significantly reduces the incidence of surgical site infection following caesarean section. This combination regimen offers improved protection against postoperative infectious morbidity and should be considered, particularly for high-risk patients undergoing caesarean delivery.