Antibiotical prophylaxy in gynecology

Czech version

Authors: J. Záhumenský; E. Menzlová; J. Zmrhal; E. Kučera
Authors‘ workplace: Gynekologicko-porodnická klinika 3. LF UK a FNKV, Praha, přednosta doc. MUDr. E. Kučera, CSc.
Published in: Ceska Gynekol 2013; 78(4): 360-364

Overview

Gynecological surgery is considered to be clear with possible contamination by gram-positive cocci from the skin, gram-negatives from the perineum or groins or polymicrobial biocenosis from vagina, depending on the surgical approach. Antibiotical prophylaxy enforces the natural mechanisms of immunity and helps to exclude present infection. There were presented many studies comparing useful effect of prophylaxis in gynecological surgery. The benefits of antibiotical prophylaxy before IUD insertion, before the cervical surgery and before hysteroscopies were not verified. On the other hand the prophylaxy of vaginal surgery including vaginal hysterectomy decreases the number of postoperative febrile complications.

The positive influence of prophylaxis before the simple laparoscopy and laparoscopy without bowel injury or the opening of the vagina was not evidently verified. In abdominal hysterectomy the antibiotical prophylaxy decreases the incidence of postoperative complications significantly. The administration of 2 g of cefazolin can be recommended. In procedures taking more than 3 hours the repeated administration of cefazolin is suitable. New urogynecological procedures, using mesh implants, were not sufficiently evaluated as for postoperative infections and the posible antibiotical effect. The presence of implant in possibly non sterile area should be considered as high risc of postoperative complications.

Keywords:
antibiotical prophylaxy – infection – gynecological surgery – hysterectomy – postoperative complications

Sources

1. ACOG practice bulletin No. 104: antibiotic prophylaxis for gynecologic procedures. Obstet Gynecol, 2009, 113, 5, p. 1180–1189.

2. Akhter, HH., Ahmed, YH., Faisel, AJ., et al. The need for prophylactic antibiotics after female sterilization: tetracyclinein Bangladesh. Contraception, 1990, 42, 3, p. 297–308.

3. Bhatia, NN., Karram, MM., Bergman, A. Role of antibiotic prophylaxis in retropubic surgery for stress urinary incontinence. Obstet Gynecol, 1989, 74, 4, p. 637–639.

4. Boulanger, L., Boukerrou, M., Rubod, C., et al. Bacteriological analysis of meshes removed for complications after surgical management of urinary incontinence or pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct, 2008, 19, 6, p. 827–831.

5. Brummer, TH., Jalkanen, J., Fraser, J., et al. FINHYST 2006-national prospective 1-year survey of 5,279 hysterectomies. Hum Reprod, 2009, 24, 10, p. 2515–2522.

6. Classen, DC., Evans, RS., Pestotnik, SL., et al. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med, 1992, 326, 5, p. 281–286.

7. Cormio, G., Vicino, M., Loizzi, V., et al. Antimicrobial prophylaxis in vaginal gynecologic surgery: a prospective randomized study comparing amoxicillin-clavulanic acid with cefazolin.J Chemother, 2007, 19, 2, p. 193–197.

8. Cruse, PJ., Foord, R. The epidemiology of wound infection. A 10-year prospective study of 62,939 wounds. Surg Clin North Am, 1980, 60, 1, p. 27–40.

9. Culligan, P., Heit, M., Blackwell, L., et al. Bacterial colony counts during vaginal surgery. Infect Dis Obstet Gynecol, 2003, 11, 3, p. 161–165.

10. Dellinger, EP., Gross, PA., Barrett, TL., et al. Quality standard for antimicrobial prophylaxis in surgical procedures. Infectious Diseases Society of America. Clin Infect Dis, 1994, 18, 3, p. 422–427.

11. Deffieux, X., Letouzey, V., Savary, D., et al. Prevention of complications related to the use of prosthetic meshes in prolapse surgery: guidelines for clinical practice. Eur J Obstet Gynecol Reprod Biol, 2012, 165, 2, p. 170–180.

12. Duff, P., Park, RC. Antibiotic prophylaxis in vaginal hysterectomy: a review. Obstet Gynecol, 1980, 55, 5, Suppl, p. 193S–202S.

13. El-Nashar, SA., Diehl, CL., Swanson, CL., et al. Extended antibiotic prophylaxis for prevention of surgical-site infections in morbidly obese women who undergo combined hysterectomy and medically indicated panniculectomy: a cohort study. Am J Obstet Gynecol, 2010, 202, 3, p. 301–306.

14. Farley, TM., Rosenberg, MJ., Rowe, PJ., et al. Intrauterine devices and pelvic inflammatory disease: an international perspective. Lancet, 1992, 339, 8796, p. 785–788.

15. Foden-Shroff, J., Redman, CW., Tucker, H., et al. Do routine antibiotics after loop diathermy excision reduce morbidity? Br J Obstet Gynaecol, 1998, 105, 9, p. 1022–1025.

16. Gregoriou, O., Bakas, P., Grigoriadis, C., et al. Antibiotic prophylaxis in diagnostic hysteroscopy: is it necessary or not? Eur J Obstet Gynecol Reprod Biol, 2012, 163, 2, p. 190–192.

17. Grimes, DA., Schulz, KF. Antibiotic prophylaxis for intrauterine contraceptive device insertion. Cochrane Database Syst Rev, 2001, 1, s. D1327.

18. Harmanli, O., Boyer, RL., Metz, S., et al. Double-blinded randomized trial of preoperative antibiotics in midurethral sling procedures and review of the literature. Int Urogynecol J, 2011, 22, 10, p. 1249–1253.

19. Harmanli, O., Hong, EK., Rubin, R., et al. Is antibiotics prophylaxis necessary for midurethral sling procedures ? A series of 174 cases without peroperative antibiotics. Int Urogynecol J, 2012, 23, 5, p. 621–623.

20. Hemsell, DL. Prophylactic antibiotics in gynecologic and obstetric surgery. Rev Infect Dis, 1991, 13, Suppl 10, p. S821–841.

21. Chan, KK., Tam, KF., Tse, KY., Ngan, HY. The use of vaginal antimicrobial after large loop excision of transformation zone: a prospective randomised trial. BJOG, 2007, 114, 8, p. 970–976.

22. Chang, WC., Lee, MC., Yeh, LS., et al. Quality-initiated prophylactic antibiotic use in laparoscopic-assisted vaginal hysterectomy. Aust N Z J Obstet Gynaecol, 2008, 48, 6, p. 592–595.

23. Kasius, JC., Broekmans, FJ., Fauser, BC., et al. Antibiotic prophylaxis for hysteroscopy evaluation of the uterine cavity. Fertil Steril, 2011, 95, 2, p. 792–794.

24. Kocak, I., Ustun, C., Emre, B., Uzel, A. Antibiotics prophylaxis in laparoscopy. Ces Gynek, 2005, 70, 4, s. 269–272.

25. Mangram, AJ. A brief overview of the 1999 CDC Guideline for the Prevention of Surgical Site Infection. Centers for Disease Control and Prevention. J Chemother, 2001, 13, Spec No 1, 1, p. 35–39.

26. McElligott, KA., Havrilesky, LJ., Myers, ER. Preoperative screening strategies for bacterial vaginosis prior to elective hysterectomy: a cost comparison study. Am J Obstet Gynecol, 2011, 205, 5, p. 500–501.

27. Meeks, DW., Lally, KP., Carrick, MM., et al. Compliance with guidelines to prevent surgical site infections: As simple as 1-2-3? Am J Surg, 2011, 201, 1, p. 76–83.

28. Nieboer, TE., Johnson, N., Lethaby, A., et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev, 2009, 3, p. D3677.

29. Phoolcharoen, N., Nilgate, S., Rattanapuntamanee, O., et al. A randomized controlled trial comparing ceftriaxone with cefazolin for antibiotic prophylaxis in abdominal hysterectomy. Int J Gynaecol Obstet, 2012, 119, 1, p. 11–13.

30. Schimpf, MO., Morrill, MY., Margulies, RU., et al. Surgeon practice patterns for antibiotic prophylaxis in gynecologic surgery. Female Pelvic Med Reconstr Surg, 2012, 18, 5, p. 281–285.

31. Swoboda, SM., Merz, C., Kostuik, J., et al. Does intraoperative blood loss affect antibiotic serum and tissue concentrations? Arch Surg, 1996, 131, 11, p. 1165–1172.

32. Tanos, V., Rojansky, N. Prophylactic antibiotics in abdominal hysterectomy. J Am Coll Surg, 1994, 179, 5, p. 593–600.

33. Thinkhamrop, J., Laopaiboon, M., Lumbiganon, P. Prophylactic antibiotics for transcervical intrauterine procedures. Cochrane Database Syst Rev, 2007, 3, s. D5637.

34. Van Eyk, N., van Schalkwyk, J. Antibiotic prophylaxis in gynaecologic procedures. J Obstet Gynaecol Can, 2012, 34, 4, p. 382–391.

35. Vollebregt, A., Troelstra, A., van der Vaart, CH. Bacterial colonisation of collagen-coated polypropylene vaginal mesh: are additional intraoperative sterility procedures useful? Int Urogynecol J Pelvic Floor Dysfunct, 2009, 20, 11, p. 1345–1351.

36. Walsh, T., Grimes, D., Frezieres, R., et al. Randomised controlled trial of prophylactic antibiotics before insertion of intrauterine devices. IUD Study Group. Lancet, 1998, 351, 9108, p. 1005–1008.