Best Antibiotic Strategy to Prevent Infection After Hysterectomy
This study by Till et al. (AJOG, 2017) aimed to determine if prophylaxis with cefazolin plus metronidazole is more effective at preventing hysterectomy surgical site infection than cefazolin or second-generation cephalosporin (current recommendation).
Retrospective Cohort Study
Data from 18,255 hysterectomies were analyzed. Surgical site infection rate was 1.8%. Infection rates were 1.8% (n=267) in the cefazolin group, 2.1% (n=49) in the second-generation cephalosporin group, and 1.4% (n=13) in the combined cefazolin/metronidazole group. After adjusting for confounders in operative and patient variables, cefazolin/metronidazole had the lowest rates of infection. Compared to cefazolin/metronidazole, cefazolin had an infection odds ratio of 2.30 (95% CI, 1.06-4.99) and second-generation cephalosporin had an odds ratio of 2.31 (95% CI, 1.21-4.41). The authors conclude that the addition of metronidazole may prevent surgical site infections following hysterectomy because of superior coverage against anaerobic vaginal flora.
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