Time to antibiotic administration in intra-amniotic infections: impact of cefoxitin monotherapy versus traditional antibiotic therapy.

OBJECTIVE

This study addresses treatment of intra-amniotic infection (IAI) by comparing timely receipt of recommended antibiotic administration between cefoxitin and traditional antimicrobial therapy, ampicillin and gentamicin, with or without clindamycin.

METHODS

This retrospective cohort study was conducted at a large, multi-site health system. The combination therapy group treated with ampicillin plus gentamicin, with or without clindamycin from June 2022 to May 2023, was compared to patients treated with cefoxitin from June 2023 to May 2024, following an institutional guideline update.

PARTICIPANTS

Pregnant individuals aged 16 and older with diagnosed or presumed IAI were included.

RESULTS

Three hundred patients were included, 150 each in both the combination therapy and cefoxitin groups. Baseline characteristics were similar between the combination therapy and cefoxitin patients. Vaginal delivery was the most common mode of delivery, and rates of cesarean delivery were similar between groups. Most patients had a negative group B Streptococcus screen. Timely receipt of antimicrobials within 60-90 minutes of order entry occurred in significantly more patients in the cefoxitin group compared to combination therapy group (69.3% vs 4.7%, P < .001). Time to recommended therapy was significantly shorter in the cefoxitin group (76.4 ± 93.3 vs 183.7 ± 228.9 min, P < .001). There were no differences in mortality, 30-day infection-related readmission, or need for additional surgical/procedural intervention.

CONCLUSIONS

Cefoxitin for IAI significantly improves timeliness of recommended antibiotic treatment, aligning with current guideline recommendations for prompt therapy. The absence of differences in secondary outcomes supports the clinical efficacy of cefoxitin and its consideration as a first-line agent in the management of IAI.