human
***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: 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 Eighteen vaginally delivered women who developed late postpartum endometritis seven to 42 days after delivery were prospect ively studied . Multiple microorganisms were recovered from the endometrium , including Chl aim ydia trachomatis , genital mycoplasmas , and a wide variety of bacteria . Erythromycin therapy was successful in ten of the 13 women who were followed OBJECTIVES To assess prospect ively the efficiency and safety of two extended spectrum cephalosporins used as pre-operative prophylaxis in nonelective cesarean sections , and compare the results to those of a third group of patients that received cefamezine post cord clamping . METHODS Two hundred and forty one patients undergoing a nonscheduled cesarean section were assigned to receive either cefonicid or ceftriaxone prior to skin incision . These patients were followed prospect ively for infectious and fetal complications . The outcome of these patients was also compared with another group of 194 patients that received cefamezine prophylaxis post cord clamping  , and whose data were collected retrospectively . Chi-square analysis of variance were performed with P < 0.05 considered significant . RESULTS There were no significant differences in the febrile complications among the two groups of patients that received pre-operative prophylaxis . However , these patients had significantly less wound infections ( P = 0.008 ) and a significantly shorter hospital stay ( P < 0.001 ) than the patients who received their prophylactic antibiotics post cord clamping . CONCLUSIONS Extended-spectrum cephalosporins , when given pre-operatively , are both effective and safe , and may have an advantage over intra-operative first generation cephalosporins in the reduction of post cesarean section infectious morbidity OBJECTIVE : To describe the effect of an extended-spectrum prophylactic antibiotic regimen on  postcesarean endometritis .  METHODS : This is a cohort study of trends in  postcesarean endometritis  using data both from prospect i ve surveillance by the infection control unit and from query of our obstetric computerized data base to compare three periods of antibiotic prophylaxis : st and ard narrow-spectrum with intravenous first- or second-generation cephalosporin ( 1992–1996 ) , clinical trial of extended-spectrum with addition of intravenous doxycycline and oral azithromycin ( 1997–1999 ) , and routine use of extended-spectrum with addition of intravenous azithromycin ( 2001–2006 ) to st and ard cephalosporin prophylaxis . RESULTS : A total of 48,913 deliveries at 24 weeks or more of gestation occurred from 1992 to 2006 , of which 10,966 ( 22.4 % ) were cesarean deliveries . Annual cesarean rates increased from 16 % to 27.5 % . Trends in the incidence of postcesarean endometritis revealed a biphasic decrease consistent with the phased introduction of extended-spectrum prophylaxis . Incidence ( 95 % confidence interval [ CI ] ) of endometritis by prospect i ve surveillance dropped from 19.9 % ( 95 % CI 18.6–21.3 % ) to 15.4 % ( 95 % CI 13.2–17.9 % ) during the clinical trial period : relative risk ( RR ) 0.77 ( 95 % CI 0.66–0.91 ) , P=.002 ; and then to 6.3 % ( 95 % CI 5.0–7.9 % ) during routine use of extended-spectrum prophylaxis : RR 0.41 ( 95 % CI 0.31–0.54 ) , P<.001 . Corresponding incidence by data base query dropped from 23 % ( 95 % CI 21.5–24.4 % ) to 16 % ( 95 % CI 14.4–17.9 % ) : RR 0.69 ( 95 % CI 0.61–0.79 ) , P<.001 ; and then to 2.1 % ( 95 % CI 1.8–2.6 % ) : RR 0.13 ( 95 % CI 0.11–0.16 ) , P<.001 . These findings were unchanged after adjusting for potential confounders . CONCLUSION : Extended-spectrum antibiotic prophylaxis involving the addition of azithromycin to st and ard narrow-spectrum prophylaxis was associated with a significant reduction in postcesarean endometritis . LEVEL OF EVIDENCE : OBJECTIVE To determine if extended spectrum prophylactic antibiotic treatment ( with efficacy against Ureaplasma urealyticum ) reduces post – cesarean delivery clinical endometritis . METHODS After cord clamping at cesarean delivery , subjects received prophylaxis with cefotetan . Subjects were then simultaneously r and omized ( double blind ) to receive doxycyline plus azithromycin versus placebo .  Post – cesarean delivery endometritis was defined clinical ly as fever of 100.4F or higher with one or more supporting clinical signs or a physician diagnosis of endometritis plus the absence of a nonpelvic source of fever . RESULTS A total of 597 women were enrolled , 301 in the doxycycline/azithromycin group and 296 in the placebo group . The study population was 56 % black , 25.5 ± 6.2 years of age , and 43 % nulliparous . The groups were similar ( P > .05 ) for black race , parity , maternal age , and most risk factors for post – cesarean delivery endometritis . The frequency of post – cesarean delivery endometritis ( 16.9 % versus 24.7 % , P = .020 ) , wound infections ( 0.8 % versus 3.6 % , P = .030 ) , and a combination of these two outcomes ( 19.0 % versus 27.8 % , P = .019 ) were significantly lower in the doxycycline/azithromycin group compared with the placebo-treated group . The doxycycline/azithromycin versus placebo groups were dissimilar for maternal leukocytosis ( 24.9 % versus 12.5 % , P = .042 ) and frequency of classic uterine incision ( 7.6 % versus 12.5 % , P = .048 ) . Adjusting for these factors did not alter the risk ratio for post – cesarean delivery endometritis in the active versus placebo-treated group ( relative risk 0.65 , 95 % confidence interval 0.43 , 0.98 ) . Length of stay was longer in the placebo group overall ( 104 ± 56 versus 95 ± 32 hours , P = .016 ) and among women with endometritis ( 146 ± 52 versus 127 ± 46 hours , P = .047 ) . CONCLUSION Extended spectrum prophylactic antibiotic treatment ( with presumed efficacy against U urealyticum ) given to women undergoing cesarean delivery at term shortens hospital stay and reduces the frequency of post – cesarean delivery endometritis and wound infections A protected , triple-lumen transcervical culture method was used to recover organisms from the endometrium . At least one facultative or one anaerobic species of bacteria was recovered from 82 % of the patients , and genital mycoplasmas were recovered from 76 % of the women with endometritis .  Bacteria together with genital mycoplasmas were present in 61 % of the women , bacteria alone were present in 20 % , genital mycoplasmas alone were present in 16 % , and Chlamydia trachomatis was isolated from 2 % of the patients . The most common organisms included Gardnerella vaginalis , Peptococcus spp . , Bacteroides spp . , Staphylococcus epidermidis , group B Streptococcus , and Ureaplasma urealyticum . A r and omized , double-blind regimen of either piperacillin or cefoxitin was equally successful in treating the postpartum endometritis 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 , this trend may be related to differences between the study groups ' risk factors for infection OBJECTIVE The purpose of this study was to characterize the pharmacokinetics of orally administered azithromycin in the term gravid woman . STUDY DESIGN Twenty women who were scheduled for elective cesarean delivery were enrolled prospect ively and received 1 g of oral azithromycin at either 6 , 12 , 24 , 72 , or 168 hours before the operation . All women received spinal anesthesia , at which time a sample of cerebrospinal fluid was obtained for analysis . Maternal serum and urine were obtained immediately before the operation . Intraoperatively , sample s of myometrium , maternal adipose tissue , placenta , amniotic fluid , and umbilical arterial and venous cord blood were obtained . Azithromycin levels were determined quantitatively with high-pressure liquid chromatography with electrochemical detection . RESULTS All participants tolerated the preoperative azithromycin without significant adverse reactions . Peak maternal serum azithromycin levels occurred within 6 hours of drug administration . Although high serum levels of azithromycin  were reached early , a rapid decline in drug concentration was noted over the initial 24 hours after the drug administration ( 6-hour : 311 ng/mL ; 24-hour : 
    Output:
    
agent
Although current guidelines for antibiotic prophylaxis recommend the administration of narrow-spectrum antibiotics ( cefazolin ) after clamping of the umbilical cord , the data suggest that antibiotic administration before surgical incision or the use of extended-spectrum regimens ( involving azithromycin or metronidazole ) after cord clamp may reduce postcesarean maternal infection by up to 50 % .
: The use of either cefazolin alone before surgical incision or an extended-spectrum regimen after cord clamp seems to be associated with a reduction in  postcesarean maternal infection .
***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: 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 Eighteen vaginally delivered women who developed late postpartum endometritis seven to 42 days after delivery were prospect ively studied . Multiple microorganisms were recovered from the endometrium , including Chl aim ydia trachomatis , genital mycoplasmas , and a wide variety of bacteria . Erythromycin therapy was successful in ten of the 13 women who were followed OBJECTIVES To assess prospect ively the efficiency and safety of two extended spectrum cephalosporins used as pre-operative prophylaxis in nonelective cesarean sections , and compare the results to those of a third group of patients that received cefamezine post cord clamping . METHODS Two hundred and forty one patients undergoing a nonscheduled cesarean section were assigned to receive either cefonicid or ceftriaxone prior to skin incision . These patients were followed prospect ively for infectious and fetal complications . The outcome of these patients was also compared with another group of 194 patients that received cefamezine prophylaxis post cord clamping  , and whose data were collected retrospectively . Chi-square analysis of variance were performed with P < 0.05 considered significant . RESULTS There were no significant differences in the febrile complications among the two groups of patients that received pre-operative prophylaxis . However , these patients had significantly less wound infections ( P = 0.008 ) and a significantly shorter hospital stay ( P < 0.001 ) than the patients who received their prophylactic antibiotics post cord clamping . CONCLUSIONS Extended-spectrum cephalosporins , when given pre-operatively , are both effective and safe , and may have an advantage over intra-operative first generation cephalosporins in the reduction of post cesarean section infectious morbidity OBJECTIVE : To describe the effect of an extended-spectrum prophylactic antibiotic regimen on  postcesarean endometritis .  METHODS : This is a cohort study of trends in  postcesarean endometritis  using data both from prospect i ve surveillance by the infection control unit and from query of our obstetric computerized data base to compare three periods of antibiotic prophylaxis : st and ard narrow-spectrum with intravenous first- or second-generation cephalosporin ( 1992–1996 ) , clinical trial of extended-spectrum with addition of intravenous doxycycline and oral azithromycin ( 1997–1999 ) , and routine use of extended-spectrum with addition of intravenous azithromycin ( 2001–2006 ) to st and ard cephalosporin prophylaxis . RESULTS : A total of 48,913 deliveries at 24 weeks or more of gestation occurred from 1992 to 2006 , of which 10,966 ( 22.4 % ) were cesarean deliveries . Annual cesarean rates increased from 16 % to 27.5 % . Trends in the incidence of postcesarean endometritis revealed a biphasic decrease consistent with the phased introduction of extended-spectrum prophylaxis . Incidence ( 95 % confidence interval [ CI ] ) of endometritis by prospect i ve surveillance dropped from 19.9 % ( 95 % CI 18.6–21.3 % ) to 15.4 % ( 95 % CI 13.2–17.9 % ) during the clinical trial period : relative risk ( RR ) 0.77 ( 95 % CI 0.66–0.91 ) , P=.002 ; and then to 6.3 % ( 95 % CI 5.0–7.9 % ) during routine use of extended-spectrum prophylaxis : RR 0.41 ( 95 % CI 0.31–0.54 ) , P<.001 . Corresponding incidence by data base query dropped from 23 % ( 95 % CI 21.5–24.4 % ) to 16 % ( 95 % CI 14.4–17.9 % ) : RR 0.69 ( 95 % CI 0.61–0.79 ) , P<.001 ; and then to 2.1 % ( 95 % CI 1.8–2.6 % ) : RR 0.13 ( 95 % CI 0.11–0.16 ) , P<.001 . These findings were unchanged after adjusting for potential confounders . CONCLUSION : Extended-spectrum antibiotic prophylaxis involving the addition of azithromycin to st and ard narrow-spectrum prophylaxis was associated with a significant reduction in postcesarean endometritis . LEVEL OF EVIDENCE : OBJECTIVE To determine if extended spectrum prophylactic antibiotic treatment ( with efficacy against Ureaplasma urealyticum ) reduces post – cesarean delivery clinical endometritis . METHODS After cord clamping at cesarean delivery , subjects received prophylaxis with cefotetan . Subjects were then simultaneously r and omized ( double blind ) to receive doxycyline plus azithromycin versus placebo .  Post – cesarean delivery endometritis was defined clinical ly as fever of 100.4F or higher with one or more supporting clinical signs or a physician diagnosis of endometritis plus the absence of a nonpelvic source of fever . RESULTS A total of 597 women were enrolled , 301 in the doxycycline/azithromycin group and 296 in the placebo group . The study population was 56 % black , 25.5 ± 6.2 years of age , and 43 % nulliparous . The groups were similar ( P > .05 ) for black race , parity , maternal age , and most risk factors for post – cesarean delivery endometritis . The frequency of post – cesarean delivery endometritis ( 16.9 % versus 24.7 % , P = .020 ) , wound infections ( 0.8 % versus 3.6 % , P = .030 ) , and a combination of these two outcomes ( 19.0 % versus 27.8 % , P = .019 ) were significantly lower in the doxycycline/azithromycin group compared with the placebo-treated group . The doxycycline/azithromycin versus placebo groups were dissimilar for maternal leukocytosis ( 24.9 % versus 12.5 % , P = .042 ) and frequency of classic uterine incision ( 7.6 % versus 12.5 % , P = .048 ) . Adjusting for these factors did not alter the risk ratio for post – cesarean delivery endometritis in the active versus placebo-treated group ( relative risk 0.65 , 95 % confidence interval 0.43 , 0.98 ) . Length of stay was longer in the placebo group overall ( 104 ± 56 versus 95 ± 32 hours , P = .016 ) and among women with endometritis ( 146 ± 52 versus 127 ± 46 hours , P = .047 ) . CONCLUSION Extended spectrum prophylactic antibiotic treatment ( with presumed efficacy against U urealyticum ) given to women undergoing cesarean delivery at term shortens hospital stay and reduces the frequency of post – cesarean delivery endometritis and wound infections A protected , triple-lumen transcervical culture method was used to recover organisms from the endometrium . At least one facultative or one anaerobic species of bacteria was recovered from 82 % of the patients , and genital mycoplasmas were recovered from 76 % of the women with endometritis .  Bacteria together with genital mycoplasmas were present in 61 % of the women , bacteria alone were present in 20 % , genital mycoplasmas alone were present in 16 % , and Chlamydia trachomatis was isolated from 2 % of the patients . The most common organisms included Gardnerella vaginalis , Peptococcus spp . , Bacteroides spp . , Staphylococcus epidermidis , group B Streptococcus , and Ureaplasma urealyticum . A r and omized , double-blind regimen of either piperacillin or cefoxitin was equally successful in treating the postpartum endometritis 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 , this trend may be related to differences between the study groups ' risk factors for infection OBJECTIVE The purpose of this study was to characterize the pharmacokinetics of orally administered azithromycin in the term gravid woman . STUDY DESIGN Twenty women who were scheduled for elective cesarean delivery were enrolled prospect ively and received 1 g of oral azithromycin at either 6 , 12 , 24 , 72 , or 168 hours before the operation . All women received spinal anesthesia , at which time a sample of cerebrospinal fluid was obtained for analysis . Maternal serum and urine were obtained immediately before the operation . Intraoperatively , sample s of myometrium , maternal adipose tissue , placenta , amniotic fluid , and umbilical arterial and venous cord blood were obtained . Azithromycin levels were determined quantitatively with high-pressure liquid chromatography with electrochemical detection . RESULTS All participants tolerated the preoperative azithromycin without significant adverse reactions . Peak maternal serum azithromycin levels occurred within 6 hours of drug administration . Although high serum levels of azithromycin  were reached early , a rapid decline in drug concentration was noted over the initial 24 hours after the drug administration ( 6-hour : 311 ng/mL ; 24-hour : 
    Output:
    