The value of prophylactic antibiotics after vaginal hysterectomy

A trial using early preoperative administration of cefonicid for antimicrobial prophylaxis with hysterectomies

A single dose of cefonicid given 3.5-5.0 hours or 0.5-1.0 hour preoperatively was compared with cefoxitin given as five doses beginning 0.5-1.0 hour preoperatively for prophylaxis of infection in 202 patients undergoing vaginal or abdominal hysterectomy. The administration of cefonicid 3.5-5.0 hours preoperatively was intended to simulate situations where surgery may be delayed or prolonged. The trial was double-blind, and patients were randomized to one of the three regimens. Operative site infections were noted in 6.2 percent of patients (7/113) who received cefonicid 3.5-5.0 hours preoperatively, in 7.0 percent of patients (3/43) who received cefonicid 0.5-1.0 hour preoperatively, and in 4.3 percent of patients (2/46) who received cefoxitin (p greater than 0.05). Enterococci were isolated most frequently from operative-site infections. When administered 3.5-5.0 hours preoperatively, cefonicid was as effective as more traditional regimens.

The prophylactic use of antimicrobials in surgery

During the period August 1976 to June 1982, there were 98 reports of antimicrobial prophylaxis in human surgery that were judged unevaluable. Our review, coupled with that of Chodak and Plaut, identified studies of 126 antibiotic regimens that were considered evaluable and a total of 205 studies considered unevaluable. A decrease in infection rate in antibiotic-treated patients compared to non-antibiotic-treated patients was seen in 120 (95%) of the evaluable regimens. Ninety-nine (79%) of these 120 regimens produced statistically significant reductions in the infection rate (P less than .05, chi 2 analysis). The majority of the antibiotic regimens were tested in procedures that were classified as clean-contaminated. Of the regimens that yielded a statistically significant reduction in infection rate with antimicrobial therapy, in 66 (67%) the agents were used for 24 hours or less. Five regimens were identified in which a higher infection rate occurred in specific patient groups when prophylactic antibiotics were used, but the differences were not statistically significant. In the overwhelming majority of evaluable studies, antibiotics decreased the incidence of surgical infection compared with non-antibiotic groups. The available data also support the effectiveness of short prophylactic antibiotic courses of 24 hours' duration or less. The duration necessary for antibiotic prophylaxis was specifically tested in nine regimens. In all nine, a short course (less than 24 hours) of antibiotic prophylaxis was as effective as longer periods of therapy (24 hours to 5 days) in preventing infection.

Ten-year review of hysterectomies: trends, indications, and risks

This report concerns the indications, morbidity, and death associated with 6,435 consecutive abdominal and vaginal hysterectomies at Hutzel Hospital during a 10 year period. There was an extraordinary number of high-risk patients included in this group. Morbidity and postoperative bleeding were more common following vaginal rather than abdominal hysterectomy. These complications were also more common when the operation was performed during the proliferative phase of the menstrual cycle. There were 17 deaths. Thromboembolic complications were the major cause of death. Selective use of prophylactic antibiotics and low-dose heparin and reduction in the number of blood transfusions by preoperative endocrine and hematinic therapy may reduce the postoperative morbidity and mortality rates. Probably few operations will ever contribute as much to improving the quality of life of women as do indicated hysterectomies. However, the added risk do not seem to justify utilizing this operation for the sole purpose of sterilization in preference to simpler and safer procedures.

Preoperative hot conization of the cervix: a possible method to reduce postoperative febrile morbidity following vaginal hysterectomy

Laboratory results indicate that the endocervix may be a source of bacterial contamination when vaginal hysterectomy is performed. In a series of 160 consecutive vaginal hysterectomies in premenopausal women, hot conization of the cervix was performed prior to the scrub with an iodophore. No preoperative antibiotics were used in this series. The postoperative febrile morbidity rate was 4.3 per cent and the average stay was 4.5 days. These results are compared with those of three other groups: (1) patients who received a three-dose parenteral prophylactic antibiotic course with the first dose two hours prior to surgery had a febrile morbidity rate of 8.6 per cent. (2) In patients who had prophylactic antibiotics for five days with the first dose given intraoperatively, the febrile morbidity rate was 10.1 per cent. (3) The febrile morbidity rate in the group with no antibiotic prophylaxis or hot conization was 49.1 per cent. Laboratory and clinical data suggest that preoperative conization may be effective in the reduction of postoperative febrile morbidity.

Prophylactic use of antibiotics in surgery

"Sound and careful surgery is the sine qua non of wound management; antimicrobials are adjunctive." The key to successful use of prophylactic antibiotics in surgery is careful selection of cases and medication. There are no final rule or formulas that will always give optimal results. Listed below are some guidelines that may assis the clinician in determining the need and form of antimicrobial use. 1. The operation must carry a significant risk of bacterial contamination. Refined-clean and clean procedures should not be given prophylactic antibiotics. 2. Bacterial cultures should be taken when possible, and the medication used for prophylaxis should be effective against the organisms expected to be encountered. 3. Narrow spectrum antibiotics should be used to conserve the body's normal flora. Broad spectrum antibiotics needed to combat resistant infections should not be used for prophylaxis. 4. The antibiotic should be present in the wound in effective concentrations at the time of the incision and be maintained only as long as the risk of new bacterial contamination exists.