***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: BACKGROUND Independent risk factors for surgical site infection ( SSI ) after cesarean section have not been well documented , despite the large number of cesarean sections performed and the relatively common occurrence of SSI . OBJECTIVE To determine independent risk factors for SSI after low transverse cesarean section . DESIGN Retrospective case-control study . SETTING Barnes-Jewish Hospital , a 1,250-bed tertiary care hospital . PATIENTS A total of 1,605 women who underwent low transverse cesarean section during the period from July 1999 to June 2001 . METHODS Using the International Classification of Diseases , Ninth Revision , Clinical Modification diagnosis codes for SSI or wound complication and /or data on antibiotic use during the surgical hospitalization or at readmission to the hospital or emergency department , we identified potential cases of SSI in a cohort of patients who underwent a low transverse cesarean section .  Cases of SSI were verified by chart review using the definitions from the Centers for Disease Control and Prevention 's National Nosocomial Infections Surveillance System . Control patients without SSI or endomyometritis were r and omly selected from the population of patients who underwent cesarean section . Independent risk factors for SSI were determined by logistic regression . RESULTS SSIs were identified in 81 ( 5.0 % ) of 1,605 women who underwent low transverse cesarean section . Independent risk factors for SSI included development of subcutaneous hematoma after the procedure ( adjusted odds ratio [ aOR ] , 11.6 [ 95 % confidence interval [ CI ] , 4.1 - 33.2 ] ) , operation performed by the university teaching service ( aOR , 2.7 [ 95 % CI , 1.4 - 5.2 ] ) , and a higher body mass index at admission ( aOR , 1.1 [ 95 % CI , 1.0 - 1.1 ] ) . Cephalosporin therapy before or after the operation was associated with a significantly lower risk of SSI ( aOR , 0.2 [ 95 % CI , 0.1 - 0.5 ] ) . Use of staples for skin closure was associated with a marginally increased risk of SSI . CONCLUSIONS These independent risk factors should be incorporated into approaches for the prevention and surveillance of SSI after surgery OBJECTIVE The purpose of this prospect i ve study was to determine whether the timing of prophylactic antibiotics at cesarean delivery influences maternal/neonatal infectious morbidity . STUDY DESIGN In this double-blind placebo-controlled trial , cefazolin was given at skin incision ( group A ) or at cord clamping ( group B ) . Patients were eligible for the trial if they had labored and required a cesarean delivery . RESULTS Over a 30-month period 303 patients with singleton pregnancies entered the trial ; 153-group A , 149-group B. Demographics , indication for cesarean delivery ( P = .54 ) , and operative time ( P = .999 ) , as well as rates of endometritis ( RR 0.67 , 95 % CI 0.42 - 1.07 ) , wound infection ( RR 0.84 , 95 % CI 0.45 - 1.55 ) , neonatal sepis ( RR 1.28 , 95 % CI 0.91 - 1.79 ) , and NICU admissions ( RR 1.28 , 95 % CI 0.91 - 1.79 ) were similar between the 2 groups . CONCLUSION There was no difference in maternal infectious morbidity whether antibiotics were given before skin incision or at cord clamping In an ongoing prospect i ve study at 2 hospitals , 114 cesarean section patients were studied to determine whether giving ampicillin after umbilical cord clamping is as effective as perioperative ampicillin in reducing maternal postoperative morbidity . The same patients have also been studied to determine the effect of prophylactic cesarean section ampicillin on the newborn . Results have shown that prophylactic ampicillin initiated after cord clamping is as effective in reducing maternal morbidity as ampicillin initiated prior to the surgery . There is also no evidence from our study that the transplacental passage of prophylactic ampicillin increases immediate or delayed neonatal infections CONTEXT Perioperative antibiotic prophylaxis during elective cesarean delivery at term to reduce postoperative maternal infectious morbidity is generally used but may not be effective on the basis of the available data . Also , the optimal timing of prophylactic antibiotic administration is unclear . OBJECTIVE To compare the effectiveness of cefazolin administered before skin incision vs cefazolin administered after umbilical cord clamping vs placebo in a 3-arm r and omized trial . The primary objective of the study was to compare postoperative infectious morbidity , defined as wound infection , endometritis , or urinary tract infection ( primary end point ) , in women with cefazolin vs placebo .  The comparison between the 2 arms administering cefazolin before skin incision vs after umbilical cord clamping was a secondary end point . DESIGN Double-blind , prospect i ve , r and omized , placebo-controlled trial . SETTING The Department of Obstetrics and Gynecology , Medical University of Vienna , Vienna , Austria . PATIENTS We recruited 1112 women undergoing elective cesarean delivery at term from March 1 , 2004 , through January 31 , 2010 . INTERVENTIONS In group 1 , cefazolin ( 2 g ) was administered 20 to 30 minutes before skin incision . In group 2 , cefazolin ( 2 g ) was administered immediately after clamping of the cord . In group 3 , placebo was administered before skin incision . RESULTS The primary outcome was observed in 18 of 370 women in group 1 ( 4.9 % ) and in 14 of 371 women in group 2 ( 3.8 % ) , whereas it was noted in 45 of 371 women in group 3 ( 12.1 % ) ( P < .001 for group 1 plus group 2 vs group 3 ) . The number needed to treat to avoid 1 primary outcome was 13 ( 95 % CI , 9 to 24 ) . Between groups 1 and 2 , there was no statistically significant difference regarding postoperative infectious morbidity ( P = .60 ) . CONCLUSION We were able to demonstrate the usefulness in elective cesarean delivery of prophylactic cefazolin vs placebo in reducing postoperative maternal infectious morbidity Objective The aim of this study was to determine whether the timing of prophylactic antibiotics at cesarean delivery influences maternal and neonatal infectious morbidity . Study design This was a prospect i ve , r and omized trial . Four hundred patients that underwent elective cesarean section between June and December 2007 formed the study population . Eleven patients were excluded from the study because they needed transfusion during the cesarean section . The population was divided into two groups : Group A , antibiotic prophylaxis was applied to 194 women before skin incision  and Group B , antibiotic prophylaxis was applied to 195 women after umbilical cord clamping . The occurrence of endomyometritis/endometritis , wound infection , febrile morbidity , total infectious morbidity , and neonatal complications were compared . Results There were 389 patients enrolled . No demographic differences were observed between groups . No significant difference was found between the groups for total infectious morbidity [ relative risk ( RR ) 1.39 , 95 % confidence interval ( CI ) 0.71–2.69 ] and endometritis ( RR 1.40 , 95 % CI 0.43–4.51 ) . There was no increase in neonatal sepsis ( RR 1.47 , 95 % CI 0.61–3.53 ) , sepsis workup ( RR 1.35 , 95 % CI 0.75–2.42 ) , need for neonatal intensive care ( RR 1.77 , 95 % CI 0.51–6.16 ) , and intensive care stay period ( P = 0.16 ) . Conclusions Time of antibiotic prophylaxis application does not change maternal infectious morbidity in cesarean section deliveries . Preoperative prophylaxis application does not affect neonate morbidity rates as stated in literature OBJECTIVE To assess whether changing the entire surgical team 's gloves intraoperatively , after delivery of the placenta , would reduce the rate of postcesarean wound infection . STUDY DESIGN Women who underwent cesarean delivery were r and omized to a group where the surgical team changed the surgical gloves after delivery of the placenta  or to a control group , where surgical gloves were not changed during the cesarean procedure . RESULTS Ninety-two patients were r and omized to 2 groups of 46 patients each . The group where the surgical team changed their gloves had significantly less serosanguineous drainage 24 hours after surgery ( 3 vs. 8 patients , 8.3 % vs. 22.2 % , P = .2 , RR 2.7 , CI 0.7 , 12.4 ) and fewer wound infections ( 2 vs. 9 women , 5.5 % vs. 25 % , P = .05 , RR 4.5 , CI 0.982 , 29.8 ) . CONCLUSION Obstetricians may decrease the number of postcesarean wound infections by having the entire team change surgical gloves after delivery of the placenta We compared maternal and neonatal outcomes in women who received prophylactic antibiotics prior to skin incision to those who received antibiotics at cord clamp .  We performed a r and omized clinical trial at two sites . Eligible women included those undergoing nonemergency cesarean at 36 weeks ' gestation or greater . Subjects were r and omized ( permuted blocks ) into one of two treatments : " preoperative antibiotics " ( cefazolin 1 g given < 30 minutes prior to skin incision ) or " intraoperative antibiotics " ( cefazolin 1 g at cord clamping ) . Patients who reported an allergy to penicillin received clindamycin 900 mg . The trial primary outcome was a composite of maternal infectious morbidities , defined as having any one of the following : ( 1 ) postoperative fever ( defined as oral temperature > 38 ° C on two separate occasions more than 6 hours apart , after the initial 24-hour postoperative period ) ; ( 2 ) wound infection ( defined as purulent discharge from the incision ) ; ( 3 ) endomyometritis ( defined as fundal tenderness and fever malodorous lochia , fever ) ; ( 4 ) urinary tract infection ( defined as fever , positive urine culture ) . We enrolled a total of 434 subjects in this study , with 217 in each group . Overall , we found no difference in composite maternal infectious morbidity between those who received antibiotics preoperatively and those who received antibiotics at cord clamp ( relative risk = 1.2 , 95 % confidence interval 0.7 to 1.5 ) . Neonatal outcomes were also similar between the two intervention arms . The rate of suspected sepsis was similar between the two groups . There were no cases of antibiotic resistance in the neonates . Either preoperative antibiotic therapy or antibiotic administration after cord clamp is a reasonable clinical method for reducing the risk of postcesarean infectious morbidity The objective of this study was to test the hypothesis that 1 g of cefazolin administered preoperatively is no more effective than the same dose administered after cord clamping in preventing postcesarean infectious morbidity .  Ninety consecutive laboring subjects undergoing cesarean delivery at > or = 37 weeks gestation were r and omized by computer to receive 1 g of cefazolin intravenously preoperatively or after cord clamping in a double-blinded , placebo-controlled study . The 2 groups were compared for differences in maternal and neonatal demographics , and intrapartum and operative characteristics associated with postcesarean infection . Primary maternal outcome variables were endometritis or wound infection . Secondary outcomes included intra-abdominal abscess formation , septic pelvic thrombophlebitis , pneumonia , or urinary tract infection . Neonatal outcomes included sepsis screens , sepsis , pneumonia , and meningitis . Subjects were followed 6 weeks postoperatively for late complications . Subjects receiving cefazolin preoperatively or after cord clamping had similar maternal and neonatal demographics , and intrapartum and operative characteristics . One patient in the former group experienced both endometritis and wound infection . In the latter group , 2 wound infections and 1 case of endometritis occurred ( P = 0.35 ) . There were no secondary maternal infections . Two infants treated for pneumonia and 2 other infants readmitted with febrile illnesses were born to mothers receiving cefazolin preoperatively . Overall , 8 neonates were evaluated for suspected sepsis and all had negative studies . Six of these infants ' mothers received cefazolin preoperatively ( P = 0.28 ) . In conclusion , 1 gram of cefazolin preoperatively is no more effective than the same dose administered after cord clamping in preventing postcesarean infectious morbidity , but is associated with a trend toward increased suspected sepsis in the newborn . However 
    Output:
    
AUTHORS ' CONCLUSIONS Based on high quality evidence from studies whose overall risk of bias is low , intravenous prophylactic antibiotics for cesarean administered preoperatively significantly decreases the incidence of composite maternal postpartum infectious morbidity as compared with administration after cord clamp .
There were no clear differences in adverse neonatal outcomes reported .
Women undergoing cesarean delivery should receive antibiotic prophylaxis preoperatively to reduce maternal infectious morbidities .