Skip to main content

Advertisement

SpringerLink
Log in

Do prophylactic antibiotics in gynecologic surgery prevent postoperative inflammatory complications? A systematic review

  • Review
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to systematically review the literature on antibiotic prophylaxis in gynaecologic surgeries to prevent inflammatory complications after gynaecological operations. The study was carried out as a systematic review.

Methods

Only randomised controlled trials of women undergoing gynaecological surgery were included. The Medline and the Cochrane library databases were searched from 1966 to 2016. The trials must have investigated an antibiotic intervention to prevent an inflammatory complication after gynaecological surgery. Trials were excluded if they were not randomised, uncontrolled or included obstetrical surgery.

Results

Prophylactic antibiotics prevent inflammatory complications after gynaecological surgery. Prophylactic antibiotics are more effective in surgery requiring access to the peritoneal cavity or the vagina. Cefotetan appears to be more capable in preventing the overall inflammatory complication rate than cefoxitin or cefazolin. No benefit has been shown for the combination of antibiotics as prophylaxis. No difference has been shown between the long-term and short-term use of antibiotics. There is no need for the primary use of an anaerobic antibacterial agent.

Conclusion

Antibiotics help to prevent postoperative inflammatory complications after major gynecologic surgeries.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Adapted from The PRISMA statement 2009 [15]

Similar content being viewed by others

References

  1. Eurostat at: http://ec.europa.eu/eurostat/web/health/health-care/data/database

  2. Harris WJ (1995) Early complications of abdominal and vaginal hysterectomy. Obstet Gynecol Surv 50(11):795–805

    Article  CAS  PubMed  Google Scholar 

  3. Stanirowski PJ, Wnuk A, Cendrowski K, Sawicki W (2015) Growth factors, silver dressings and negative pressure wound therapy in the management of hard-to-heal postoperative wounds in obstetrics and gynecology: a review. Arch Gynecol Obstet 292(4):757–775

    Article  PubMed  PubMed Central  Google Scholar 

  4. Dicker RC, Greenspan JR, Strauss LT, Cowart MR, Scally MJ, Peterson HB et al (1982) Complications of abdominal and vaginal hysterectomy among women of reproductive age in the United States. The Collaborative Review of Sterilization. Am J Obstet Gynecol 144(7):841–848

    Article  CAS  PubMed  Google Scholar 

  5. Rogers RG, Kammerer-Doak D, Olsen A, Thompson PK, Walters MD, Lukacz ES et al (2004) A randomised, double-blind, placebo-controlled comparison of the effect of nitrofurantoin monohydrate macrocrystals on the development of urinary tract infections after surgery for pelvic organ prolapse and/or stress urinary incontinence with suprapubic catheterization. Am J Obstet Gynecol 191(1):182–187

    Article  CAS  PubMed  Google Scholar 

  6. Cormio G, Di Fazio F, Cacciapuoti C, Bettocchi S, Borraccino L, Selvaggi L (2003) Prospective randomised study comparing amoxicillin-clavulanic acid with cefazolin as antimicrobial prophylaxis in laparotomic gynecologic surgery. Acta Obstet Gynecol Scand 82(12):1130–1134

    Article  PubMed  Google Scholar 

  7. Fram KM (2002) Laparoscopically assisted vaginal hysterectomy vs. abdominal hysterectomy in stage I endometrial cancer. Int J Gynecol Cancer 12(1):57–61

  8. Leaper DJ, van Goor H, Reilly J, Petrosillo N, Geiss HK, Torres AJ, Berger A (2004) Surgical site infection—a European perspective of incidence and economic burden. Int Wound J 1(4):247–273

  9. Periti P, Mazzei T, Periti E (1988) Prophylaxis in gynecological and obstetric surgery: a comparative randomised multicentre study of single-dose cefotetan vs. two doses of cefazolin. Chemioterapia 7(4):245–252

  10. Mangioni C, Bianchi L, Bolis PF, Lomeo AM, Mazzeo F, Ventriglia (1991) Multicentre trial of prophylaxis with clindamycin plus aztreonam or cefotaxime in gynecologic surgery. Rev Infect Dis 13(Suppl 7):S621–S625

  11. Wttewaall-Evelaar EW (1990) Meta-analysis of randomized controlled trials of antibiotic prophylaxis in abdominal hysterectomy. Pharm Weekly Sci 12(6A):296298 (discussion 299)

  12. Bowler PG, Welsby S, Towers V, Booth R, Hogarth A, Rowlands V, Joseph A, Jones SA (2012) Multidrug-resistant organisms, wounds and topical antimicrobial protection. Int Wound J 9(4):387–396

    Article  PubMed  Google Scholar 

  13. Mir MA, Malik UY, Wani H, Bali BS (2013) Prevalence, pattern, sensitivity and resistance to antibiotics of different bacteria isolated from port site infection in low risk patients after elective laparoscopic cholecystectomy for symptomatic cholelithiasis at tertiary care hospital of Kashmir. Int Wound J 10(1):110–113

    Article  PubMed  Google Scholar 

  14. Prisma statement at: http://www.prisma-statement.org

  15. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol

  16. Chongsomchai C, Lumbiganon P, Thinkhamrop J, Ounchai J, Vudhikamraksa N (2002) Placebo-controlled, double-blind, randomised study of prophylactic antibiotics in elective abdominal hysterectomy. J Hosp Infect 52(4):302–306

    Article  CAS  PubMed  Google Scholar 

  17. Mamsen A, Hansen V, Moller BR (1992) A prospective randomised double-blind trial of ceftriaxone vs. no treatment for abdominal hysterectomy. Eur J Obstet Gynecol Reprod Biol 47(3):235–238

  18. Houang ET, Watson C, Howell R, Chapman M (1984) Ampicillin combined with sulbactam or metronidazole for single-dose chemoprophylaxis in major gynecological surgery. J Antimicrob Chemother 14(5):529–535

    Article  CAS  PubMed  Google Scholar 

  19. Henriksson L, Colling-Saltin AS, Frick G, Kullander S, Sandholm LE, Ursing J, Cederberg A (1998) Metronidazole prophylaxis to prevent infections after total abdominal hysterectomy. Acta Obstet Gynecol Scand 77(1):116–119

    Article  CAS  PubMed  Google Scholar 

  20. Boodt PJ, Snijders WP, Janknegt R (1990) Single-dose prophylaxis in hysterectomies. An interim analysis. Pharm Weekbl Sci 12(6A):280–283

    Article  CAS  PubMed  Google Scholar 

  21. Hemsell DL, Bernstein SG, Bawdon RE, Hemsell PG, Heard MC, Nobles BJ (1989) Preventing major operative site infection after radical abdominal hysterectomy and pelvic lymphadenectomy. Gynecol Oncol 35(1):55–60

    Article  CAS  PubMed  Google Scholar 

  22. Phoolcharoen N, Nilgate S, Rattanapuntamanee O, Limpongsanurak S, Chaithongwongwatthana S (2012) A randomized controlled trial comparing ceftriaxone with cefazolin for antibiotic prophylaxis in abdominal hysterectomy. Int J Gynaecol Obstet 119(1):11–13

    Article  CAS  PubMed  Google Scholar 

  23. Cormio G, Vicino M, Loizzi V, Tangari D, Selvaggi L (2007) Antimicrobial prophylaxis in vaginal gynecologic surgery: a prospective randomized study comparing amoxicillin-clavulanic acid with cefazolin. J Chemother 19(2):193–197

    Article  CAS  PubMed  Google Scholar 

  24. Hemsell DL, Johnson ER, Hemsell PG, Nobles BJ, Little BB, Heard MC (1995) Cefazolin is inferior to cefotetan as single-dose prophylaxis for women undergoing elective total abdominal hysterectomy. Clin Infect Dis 20(3):677–684

    Article  CAS  PubMed  Google Scholar 

  25. Roy S, Hemsell D, Gordon S, Godwin D, Pearlman M, Luke D (1998) Oral trovafloxacin compared with intravenous cefoxitin in the prevention of bacterial infection after elective vaginal or abdominal hysterectomy for non-malignant disease. Trovafloxacin Surgical Group. Am J Surg 176(6A Suppl):62S–66S

    Article  CAS  PubMed  Google Scholar 

  26. Faro S, Pastorek JG, Aldridge KE, Nicaud S, Cunningham G (1988) Randomised double-blind comparison of mezlocillin vs. cefoxitin prophylaxis for vaginal hysterectomy. Surg Gynecol Obstet 166(5):431–435

    CAS  PubMed  Google Scholar 

  27. Kauer FM, Wijma J, Manson WL (1990) Vaginal hysterectomy: cefuroxime, metronidazole or both? Pharm Weekbl Sci 12(6A):284–288

    Article  CAS  PubMed  Google Scholar 

  28. Ledger WJ, Gee C, Lewis WP (1975) Guidelines for antibiotic prophylaxis in gynecology. Am J Obstet Gynecol 121(8):1038–1045

    Article  CAS  PubMed  Google Scholar 

  29. Triolo O, Mancuso A, Pantano F (2004) Amoxycillin/clavulanate prophylaxis in gynecologic surgery. Int J Gynaecol Obstet 85(1):59–61

    Article  CAS  PubMed  Google Scholar 

  30. Periti P, Mazzei T, Orlandini F, Mini E (1988) Comparison of the antimicrobial prophylactic efficacy of cefotaxime and cephazolin in obstetric and gynecological surgery. A randomised multicentre study. Drugs 35(Suppl 2):133–138

    Article  PubMed  Google Scholar 

  31. Hemsell DL, Johnson ER, Heard MC, Hemsell PG, Nobles BJ, Bawdon RE (1989) Single-dose piperacillin vs. triple-dose cefoxitin prophylaxis at vaginal and abdominal hysterectomy. South Med J 82(4):438–442

    Article  CAS  PubMed  Google Scholar 

  32. Sevin BU, Ramos R, Gerhardt RT, Guerra L, Hilsenbeck S, Averette HE (1991) Comparative efficacy of short-term vs. long-term cefoxitin prophylaxis against postoperative infection after radical hysterectomy: a prospective study. Obstet Gynecol 77(5):729–734

    CAS  PubMed  Google Scholar 

  33. Chang WC, Hung YC, Li TC, Yang TC, Chen HY, Lin CC (2005) Short course of prophylactic antibiotics in laparoscopically assisted vaginal hysterectomy. J Reprod Med 50(7):524–528

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Plastic, Reconstructive, Hand and Burn Surgery, BG Trauma Center, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076, Tuebingen, Germany

    Cedric Emanuel Boesch, Roderick Franziskus Pronk, Fabian Medved, Pascal Hentschel & Hans-Eberhard Schaller

  2. Department of Gynecology and Obstetrical Surgery, Medical University Vienna, Vienna, Austria

    Wolfgang Umek

Authors
  1. Cedric Emanuel Boesch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Roderick Franziskus Pronk
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fabian Medved
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Pascal Hentschel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hans-Eberhard Schaller
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wolfgang Umek
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

CEB: Data collection, manuscript writing and editing. RFP: Data collection and Data analysis. FM: Data analysis. PH: Data analysis. HES: Manuscript editing, management. WU: Manuscript writing and editing, management

Corresponding author

Correspondence to Cedric Emanuel Boesch.

Ethics declarations

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors. This article does not contain any studies with animals performed by any of the authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Boesch, C.E., Pronk, R.F., Medved, F. et al. Do prophylactic antibiotics in gynecologic surgery prevent postoperative inflammatory complications? A systematic review. Arch Gynecol Obstet 295, 1383–1391 (2017). https://doi.org/10.1007/s00404-017-4382-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-017-4382-0

Keywords

Search

Navigation