(1104) Azithromycin utilization and maternal outcomes in patients with intrapartum cesarean birth, 2016-2020

This retrospective cohort study used the Premier Healthcare Database to identify births from 2016-2020 in patients aged 12 to 55, at > 24 weeks’ gestation, with a singleton pregnancy and intrapartum cesarean or cesarean after rupture of membranes. Those with chorioamnionitis prior to delivery were excluded. The primary outcome was azithromycin use. Secondary outcomes were a composite endpoint of infectious and surgical wound complications, endometritis, necrotizing fasciitis, abscess, septic pelvic thrombophlebitis, sepsis, pyelonephritis, pneumonia, meningitis and death during delivery hospitalization or the following 30 days.


Results: From 2016 to 2020, there were 1,528,602 cesarean deliveries, of which 531,709 met inclusion criteria. Azithromycin recipients were more likely than Azithyromicin non-recipients to have diabetes, hypertension, and tobacco use disorder. Azithromycin use increased from < 1% to nearly 40% from 2016-2020 (Figure). Utilization was highest in hospitals with > 500 beds compared to hospitals with < 100 beds (41.4% vs 4.7% p < 0.001). Despite increasing azithromycin use, the composite outcome was higher among patients receiving Azithyromicin, as was endometritis, length of stay, and home health use (Table).

Conclusion: After C/SOAP, the uptake of azithromycin was rapid and faster in larger hospitals. Further implementation should focus on smaller rural hospitals where uptake remains low, which may reflect limited financial resources, or capacity for implementation. Given outcomes assessment was limited to inpatient encounters and this cohort was not randomized, we encourage caution when evaluating associations between azithromycin exposure and outcomes.