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PROPHYLACTIC ANTIBIOTICS PRIOR TO CESAREAN SECTION IN OBESE WOMEN

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ClinicalTrials.gov Identifier: NCT01810354
Recruitment Status : Completed
First Posted : March 13, 2013
Last Update Posted : July 24, 2014
Sponsor:
Information provided by (Responsible Party):
Lindsay Maggio,, Women and Infants Hospital of Rhode Island

Study Description
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Brief Summary:

Surgical site infections are common and a cause of major morbidity. They are also more common in obese women. Cesarean sections are the most common surgery performed in the United States, therefore pregnant women are being faced with this problem frequently. There is evidence to show that prophylactically administered antibiotics, cefazolin specifically, to obese women prior to cesarean section do not reach adequate concentrations in adipose tissue to prevent infection. The purpose of this study is to evaluate if an increased dose of cefazolin will attain adequate tissue concentration in obese women. Our hypothesis is that three grams of cefazolin given no more than 60 minutes prior to the start of a cesarean section in an obese (Body mass index (BMI) greater than or equal to 30) woman will attain adequate adipose tissue concentration compared to two grams of cefazolin.

Subjects will be selected if they are greater than 37 weeks gestation wiht a singleton pregnancy and require a cesarean section for any obstetrical indication. Women will be excluded if they have a suspected infection, have a multiple gestation, or have preexisting diabetes or hypertension with end organ damage. The subjects will be screened both by through the OR schedule as well as through the clinics. They will then be consented and enrolled by the primary investigator. Once enrolled the subjects will be randomized to receive either two grams or three grams of cefazolin as prophylactic antibiotics to be given no more than 60 minutes prior to the start of the surgery.

Two adipose tissue samples will be obtained at the time of surgery. The first at the start after skin incision and the second at the end prior to closure of the skin. There will also be a separate IV placed at the start of the procedure from which three blood draws can be collected. These three samples will be obtained at the start of the surgery but after antibiotic administration, at the time of the first adipose collection, and at the time of the second adipose collection. The samples will then be stored at -80 degrees and shipped to David P. Nicolau's lab in Hartford, CT for the tissue and serum analysis.

While the subjects are in the hospital recovering from their surgery, a chart review will be performed to determine if there are any infections occuring post-operatively. A telephone survey will be conducted six to eight weeks postpartum again assessing for any infectious complications after the cesarean section.


Condition or disease Intervention/treatment Phase
Infection Prevention Drug: Cefazolin Not Applicable

Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 58 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Prevention
Official Title: PROPHYLACTIC ANTIBIOTICS PRIOR TO CESAREAN SECTION IN OBESE WOMEN: Does Increasing the Dose Increase the Tissue Concentration?
Study Start Date : April 2013
Actual Primary Completion Date : July 2014
Actual Study Completion Date : July 2014

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Arms and Interventions
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Arm Intervention/treatment
Experimental: Two grams cefazolin
Two grams of cefazolin will be given by intravenous bolus zero to 60 minutes prior to the start of the cesarean section.
 Drug: Cefazolin
Active Comparator: Three grams cefazolin
Three grams of cefazolin will be given by intravenous bolus zero to 60 minutes prior to the start of the cesarean section.
 Drug: Cefazolin


Outcome Measures
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Primary Outcome Measures :
  1. Adipose tissue concentration of cefazolin [ Time Frame: At the start of the cesarean section and at the end of the cesarean section ]
    Two separate two gram samples of adipose tissue will be removed from the subcutaneous tissue. The first sample will be removed after skin incision, yet prior to fascial incision. The second sample will be collected after fascial closure, yet prior to skin closure.


Secondary Outcome Measures :
  1. Serum cefazolin concentrations [ Time Frame: After antibiotic infusion, at the start of the cesarean section, and at the end of the cesarean section ]
    Three separate intraoperative blood samples will be collected to evaluate the serum cefazolin concentrations. The first sample will be collected after antibiotic administration, prior to the surgery start. The next two samples will be collected coincidental to the time of adipose tissue collection. The first after skin incision, yet prior to fascial incision. The second after fascial closure, yet prior to skin closure.


Other Outcome Measures:
  1. Infectious morbidity [ Time Frame: Participants will be followed for a duration of 6-8 weeks after the cesarean section ]
    While in the hospital, chart reviews of the subject will be performed to identify any infectious complications. A follow-up telephone survey will be conducted to assess for this outcome as well at six to eight weeks after surgery.


Eligibility Criteria
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Ages Eligible for Study:   Child, Adult, Older Adult
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • Obese - body mass index (BMI) calculated as weight (kg)/ [height (m2)]greater than or equal to 30 as determined at their first prenatal visit
  • Gestational age of 37 0/7 weeks and greater
  • Singleton Pregnancy
  • Non-emergent cesarean section

Exclusion Criteria:

  • Known cephalosporin allergy
  • Severe allergy to penicillin making cephalosporin use a contraindication
  • Exposure to antibiotics in the preceding 7 days
  • Need for emergent cesarean section
  • Multiple gestations
  • Suspected chorioamnionitis
  • Pre-gestational diabetes
  • Chronic hypertension with evidence of end organ damage
Contacts and Locations
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Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01810354


Locations
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United States, Rhode Island
Women & Infants Hospital
Providence, Rhode Island, United States, 02905
Sponsors and Collaborators
Women and Infants Hospital of Rhode Island
Investigators
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Principal Investigator: Lindsay Maggio, MD Women & Infant's Hospital
Study Director: Brenna Anderson, MD Women & Infants Hospital
More Information
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Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

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Responsible Party: Lindsay Maggio,, Maternal-Fetal Medicine Fellow, Women and Infants Hospital of Rhode Island
ClinicalTrials.gov Identifier: NCT01810354    
Other Study ID Numbers: 13-0004
First Posted: March 13, 2013    Key Record Dates
Last Update Posted: July 24, 2014
Last Verified: July 2014
Keywords provided by Lindsay Maggio,, Women and Infants Hospital of Rhode Island:
Cefazolin
Tissue concentration
infection
cesarean section
obese
Additional relevant MeSH terms:
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Infection
Cefazolin
Anti-Bacterial Agents
Anti-Infective Agents