Prophylactic Antibiotics for Abdominal and Vaginal Hysterectomy

  • David L. Hemsell
Part of the Clinical Perspectives in Obstetrics and Gynecology book series (CPOG)

Abstract

Adoption of the Diagnosis-Related Groups (DRG) concept has altered many aspects of health care, and may be the impetus necessary to alter the overutilization of antimicrobials for the prevention of major infection after hysterectomy. There is no disagreement about the necessity to prevent infection in the pelvis or in the abdominal wound following hysterectomy. Hospital stay may be prolonged for up to 2 weeks if an infection develops. Because of the pathogens involved, abscesses may form and a second operative procedure may be required. Gynecologic surgeons are interested in a zero percent incidence of infection. Even with antimicrobial prophylaxis, this standard is usually not attainable. Major infection after hysterectomy with prophylaxis is between 5% and 10%. If the incidence of major infection without prophylaxis is within this range, prophylaxis is not indicated, unless the gynecologist can identify a high-risk group of patients.

Keywords

Obesity Penicillin Ampicillin Tetracycline Gentamicin 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    DiPiro JT, Record KE, Schanzenbach KS, et al. Antimicrobial prophylaxis in surgery: Part 1. Am J Hosp Pharm. 1981; 38: 320–334.PubMedGoogle Scholar
  2. 2.
    Dicker RC, Greenspan JR, Strauss LT, et al. Complications of abdominal and vaginal hysterectomy among women of reproductive age in the United States. The collaborative review of sterilization. Am J Obstet Gynecol. 1982; 144: 841–848.PubMedGoogle Scholar
  3. 3.
    Gray LA. Open cuff method of abdominal hysterectomy. Obstet Gynecol. 1975; 46: 42–46.PubMedCrossRefGoogle Scholar
  4. 4.
    Falk HC, Bunkin IA. A study of 500 vaginal hysterectomies. Am J Obstet Gynecol. 1946; 52: 623–630.PubMedGoogle Scholar
  5. 5.
    Ledger WJ, Child MA. The hospital care of patients undergoing hysterectomy: an analysis of 12,026 patients from the Professional Activity Study. Am J Obstet Gynecol. 1973; 117: 423–433.PubMedGoogle Scholar
  6. 6.
    Mayer W, Gordon M, Rothbard MJ. Prophylactic antibiotics. Use in hysterectomy. NY State J Med. 1976; 76: 2144–2147.Google Scholar
  7. 7.
    Appelbaum PC, Moodley J, Chatterton SA, et al. Metronidazole in the prophylaxis and treatment of anaerobic infection. S Afr Med J. 1978; 54: 703–706.PubMedGoogle Scholar
  8. 8.
    Appelbaum PC, Moodley J, Chatterton SA, et al. Tinidazole in the prophylaxis and treatment of anaerobic infection. Chemotherapy. 1980; 26: 145–151.PubMedCrossRefGoogle Scholar
  9. 9.
    Roberts JM, Homesley HD. Low-dose carbenicillin prophylaxis for vaginal and abdominal hysterectomy. Obstet Gynecol. 1978; 52: 83–87.PubMedGoogle Scholar
  10. 10.
    Mendelson J, Portnoy J, DeSaint Victor JR, et al. Effect of single and multidose cephradine pro phylaxis on infectious morbidity of vaginal hysterectomy. Obstet Gynecol. 1979; 53: 31–35.PubMedGoogle Scholar
  11. 11.
    Swartz WH. Prophylaxis of minor febrile and major infectious morbidity following hysterectomy. Obstet Gynecol. 1979; 54: 284–288.PubMedGoogle Scholar
  12. 12.
    Shapiro M, Schoenbaum SC, Tager IB, et al. Benefit-cost analysis of antimicrobial prophylaxis in abdominal and vaginal hysterectomy. JAMA. 1983; 249: 1290–1294.PubMedCrossRefGoogle Scholar
  13. 13.
    Bivens MD, Neufeld J, McCarty WD. The prophylactic use of Keflex and Keflin in vaginal hysterectomy. Am J Obstet Gynecol. 1975; 122: 169–175.PubMedGoogle Scholar
  14. 14.
    Mathews DD, Agarwal V, Gordon AM, et al. A double-blind trial of single-dose chemoprophylaxis with co-trimoxazole during vaginal hyster ectomy and repair. Br J Obstet Gynecol. 1979; 86: 737–740.CrossRefGoogle Scholar
  15. 15.
    Vincelette J, Finkelstein F, Aoki FY, et al. Double-blind trial of perioperative intravenous metronidazole prophylaxis for abdominal and vaginal hysterectomy. Surgery. 1983; 93: 185–189.PubMedGoogle Scholar
  16. 16.
    Ohm MJ, Galask RP. The effect of antibiotic prophylaxis on patients undergoing total abdominal hysterectomy. I. Effect on morbidity. Am J Obstet Gynecol. 1976; 125: 442–447.PubMedGoogle Scholar
  17. 17.
    Swartz WH, Tanaree P. T-tube suction drainage and/or prophylactic antibiotics: a randomized study of 451 hysterectomies. Obstet Gynecol. 1976; 47: 665–670.PubMedGoogle Scholar
  18. 18.
    Mathews DD, Ross H, Cooper J. A double-blind trial of single-dose chemoprophylaxis with co- trimoxazole during total abdominal hysterec tomy. Br J Obstet Gynecol. 1977; 84: 894–897.CrossRefGoogle Scholar
  19. 19.
    Grossman JH III, Greco TP, Minkin MJ, et al. Prophylactic antibiotics in gynecologic surgery. Obstet Gynecol. 1979; 53: 537–544.PubMedGoogle Scholar
  20. 20.
    Creasman WT, Hill GB, Weed JC Jr, et al. A trial of prophylactic cefamandole in extended gynecologic surgery. Obstet Gynecol. 1982; 59: 309–314.PubMedGoogle Scholar
  21. 21.
    Duff P. Antibiotic prophylaxis for abdominal hysterectomy. Obstet Gynecol. 1982: 60: 25–29.PubMedGoogle Scholar
  22. 22.
    Stage AH, Glover DD, Vaughan JE. Low-dose cephradine prophylaxis in obstetric and gynecologic surgery. J Reprod Med. 1982; 27: 113–119.PubMedGoogle Scholar
  23. 23.
    Popkin DR, Martinez LA, Carswell GA. Metronidazole in the prophylaxis of anaerobic infections in gynecologic surgery. Surgery. 1983; 93: 180–184.PubMedGoogle Scholar
  24. 24.
    Savage EW, Thadepalli H, Rambhatla K, et al. Minocycline prophylaxis in elective hysterectomy. J Reprod Med. 1984; 29: 81–87.PubMedGoogle Scholar
  25. 25.
    Taylor ES, Hansen RR. Morbidity following vaginal hysterectomy and colpoplasty. Obstet Gynecol. 1961; 17: 346–348.PubMedGoogle Scholar
  26. 26.
    Pratt JH, Galloway JR. Vaginal hysterectomy in patients less than 36 or more than 60 years of age. Am J Obstet Gynecol. 1965; 93: 812–821.PubMedGoogle Scholar
  27. 27.
    Shapiro M, Munoz A, Tager IB, et al. Risk factors for infection at the operative site after abdominal or vaginal hysterectomy. N Engl J Med. 1982; 307: 1661–1666.PubMedCrossRefGoogle Scholar
  28. 28.
    Goosenberg J, Emich JP Jr, Schwarz RH. Pro-phylactic antibiotics in vaginal hysterectomy. Am J Obstet Gynecol. 1969; 105: 503–506.PubMedGoogle Scholar
  29. 29.
    Boiling DR Jr, Plunkett GD. Prophylactic antibiotics for vaginal hysterectomies. Obstet Gynecol. 1973; 41: 689–692.Google Scholar
  30. 30.
    Scott JR. Pelvic infections following vaginal hysterectomy. Hosp Pract. 1973; 8: 101–110.Google Scholar
  31. 31.
    Jackson C, Amstey MS. Prophylactic ampicillin therapy for vaginal hysterectomy. Surg Gynecol Obstet. 1975; 141: 755–757.PubMedGoogle Scholar
  32. 32.
    Boyd ME, Garceau R. The value of prophylactic antibiotics after vaginal hysterectomy. Am J Ob stet Gynecol. 1976; 125: 581–585.Google Scholar
  33. 33.
    Holman JF, McGowan JE, Thompson JD. Perioperative antibiotics in major elective gynecologic surgery. South Med J. 1978; 71: 417–420.PubMedCrossRefGoogle Scholar
  34. 34.
    Lett WJ, Ansbacher R, Davison BL, et al. Prophylactic antibiotics for women undergoing vaginal hysterectomy. J Reprod Med. 1977; 19: 51–54.PubMedGoogle Scholar
  35. 35.
    Jacobson JA, Hebertson R, Kasworm E. Comparison of ceforanide and cephalothin prophylaxis for vaginal hysterectomies. Antimicrob Agents Chemother. 1982; 22: 643–647.PubMedGoogle Scholar
  36. 36.
    Osborne NG, Wright RC, Grubin L. Genital bacteriology: a comparative study of premenopausal women with postmenopausal women. Am J Obstet Gynecol. 1979; 135: 195–198.PubMedGoogle Scholar
  37. 37.
    Thadepalli H, Savage EW Jr, Salem FA, et al. Cyclic changes in cervical microflora and their effect on infections following hysterectomy. Gynecol Obstet Invest. 1982; 14: 176–183.PubMedCrossRefGoogle Scholar
  38. 38.
    Sprague AD, van Nagell JR Jr. The relationship of age and endometrial histology to blood loss and morbidity following vaginal hysterectomy. Am J Obstet Gynecol. 1974; 118: 805–808.PubMedGoogle Scholar
  39. 39.
    Gallup DG. Modification of celiotomy tech- niques to decrease morbidity in obese gynecologic patients. Am J Obstet Gynecol. 1984; 150: 171–178.PubMedGoogle Scholar
  40. 40.
    Pitkin RM. Abdominal hysterectomy in obese women. Surg Gynecol Obstet. 1976; 142: 532–536.PubMedGoogle Scholar
  41. 41.
    Pitkin RM. Vaginal hysterectomy in obese women. Obstet Gynecol. 1977; 49: 567–569.PubMedGoogle Scholar
  42. 42.
    Ohm MJ, Galask RP. The effect of antibiotic prophylaxis on patients undergoing vaginal operations. I. The effect on morbidity. Am J Obstet Gynecol. 1975; 123: 590–596.PubMedGoogle Scholar
  43. 43.
    Allen JL, Rampone JF, Wheeless CR. Use of a prophylactic antibiotic in elective major gynologic operations. Obstet Gynecol. 1972; 39: 218–224.PubMedGoogle Scholar
  44. 44.
    Poulsen HK, Borel J, Olsen H. Prophylactic metronidazole or suction drainage in abdominal hysterectomy. Obstet Gynecol. 1984; 63: 291–294.PubMedGoogle Scholar
  45. 45.
    Breeden JT, Mayo JE. Low dose prophylactic antibiotics in vaginal hysterectomy. Obstet Gynecol. 1974; 43: 379–385.PubMedGoogle Scholar
  46. 46.
    Hemsell DL, Cunningham FG, Kappus S, et al. Cefoxitin for prophylaxis in premenopausal women undergoing vaginal hysterectomy. Obstet Gynecol. 1980; 56: 629–634.PubMedGoogle Scholar
  47. 47.
    Hemsell D, Hemsell P, Nobles B, et al. Moxalactam versus cefazolin prophylaxis for vaginal hysterectomy. Am J Obstet Gynecol. 1983; 147: 379–385.PubMedGoogle Scholar
  48. 48.
    Hemsell DL, Reisch J, Nobles B, et al. Prevention of major infection after elective abdominal hysterectomy: Individual determination required. Am J Obstet Gynecol. 1983; 147: 520–528.PubMedGoogle Scholar
  49. 49.
    Hemsell DL, Heard ML, Nobles BJ, et al. Single-dose cefoxitin prophylaxis for premenopausal women undergoing vaginal hysterectomy. Obstet Gynecol. 1984; 63: 285–290.PubMedGoogle Scholar
  50. 50.
    Hemsell DL, Johnson ER, Bawdon RE, et al. Cefoperazone and cefoxitin prophylaxis for abdominal hysterectomy. Obstet Gynecol. 1984; 63: 467–472.PubMedGoogle Scholar
  51. 51.
    Hemsell DL, Johnson ER, Bawdon RE, et al. Ceftriaxone and cefazolin prophylaxis for hysterectomy. Surg Gynecol Obstet. 1985; 161: 197–203.PubMedGoogle Scholar
  52. 52.
    Hemsell DL, Hemsell PG, Heard ML, et al. Pre-operative cefoxitin prophylaxis for elective abdominal hysterectomy. Am J Obstet Gynecol. 1985; 153: 225–226.PubMedGoogle Scholar
  53. 53.
    Crori RS, Stauffer J, Paegel H Jr. Morbidity studies in one thousand consecutive hysterectomies. Am J Obstet Gynecol. 1952; 63: 344–350.Google Scholar
  54. 54.
    Polk BF, Tager IB, Shapiro M, et al. Randomised clinical trial of perioperative cefazolin in preventing infection after hysterectomy. Lancet. 1980; 1: 437–441.PubMedCrossRefGoogle Scholar
  55. 55.
    Turner SJ. The effect of penicillin vaginal sup-positories on morbidity in vaginal hysterectomy and on the vaginal flora. Am J Obstet Gynecol. 1950; 60: 806–812.PubMedGoogle Scholar
  56. 56.
    Ledger WJ, Sweet RL, Headington JT. Prophlactic cephaloridine in the prevention of postoperative pelvic infections in premenopausal women undergoing vaginal hysterectomy. Am J Obstet Gynecol. 1973; 115: 766–774.PubMedGoogle Scholar
  57. 57.
    Mickal A, Curole D, Lewis C. Cefoxitin sodium: double-blind vaginal hysterectomy prophylaxis in premenopausal patients. Obstet Gynecol. 1980; 56: 222–225.PubMedGoogle Scholar
  58. 58.
    Wideman GL, Matthijssen C. Comparative efficacy of cefotaxime and cefazolin as prophylaxis against infections following elective hysterectomy. Clin Ther. 1982; 5(Suppl. A): 67–73.PubMedGoogle Scholar
  59. 59.
    Roy S, Wilkin J. Comparison of cerfotaxime with cefazolin for prophylaxis of vaginal or abdominal hysterectomy. Clin Ther. 1982; 5(Suppl. A): 74–82.PubMedGoogle Scholar
  60. 60.
    Hemsell DL, Menon MO, Friedman AJ. Ceftriaxone or cefazolin for prophylaxis for the prevention of infection following vaginal hysterectomy. Am J Surg. 1984; 148(4A): 22–26.PubMedGoogle Scholar
  61. 61.
    Hamod KA, Spence MR, Rosenshein NB, et al. Single-dose and multidose prophylaxis in vaginal hysterectomy: a comparison of sodium cephalothin and metronidazole. Am J Obstet Gynecol. 1980; 136: 976–979.PubMedGoogle Scholar
  62. 62.
    Burke JF. The effective period of preventive antibiotic action in experimental incisions and dermal lesions. Surgery. 1961; 50: 161–168.PubMedGoogle Scholar
  63. 63.
    French MA, Quintiliani R, Nightingale CH, et al. Serum and tissue concentrations of cefoxitin and cefamandole in women undergoing hysterectomy. Obstet Gynecol. 1983; 61: 42–47.PubMedGoogle Scholar
  64. 64.
    Neu HC. Clinical pharmacokinetics in preventive antimicrobial therapy. South Med J. 1977; 70(Suppl. 1): 14–24.PubMedGoogle Scholar
  65. 65.
    Cunningham FG, Hemsell DL, DePalma RT, et al. Moxalactam for obstetric and gynecologic infections. In Vitro and dose-finding studies. Am J Obstet Gynecol. 1981; 139: 915–921.PubMedGoogle Scholar
  66. 66.
    Gibbs RS, Blanco JD, Duff P, et al. A double- blind randomized comparison of moxalactam versus clindamycin-gentamicin in treatment of endomyometritis after cesarean section delivery. Am J Obstet Gynecol. 1983; 146: 769–772.PubMedGoogle Scholar
  67. 67.
    Hemsell DL, Cunningham FG, DePalma RT, et al. Cefotaxime sodium therapy for endomyometritis following cesarean section: dose-finding and comparative studies. Obstet Gynecol. 1983; 62: 489–497.PubMedGoogle Scholar
  68. 68.
    Gilstrap LC III, Maier RC, Gibbs RS, et al. Piperacillin versus clindamycin plus gentamicin for pelvic infections. Obstet Gynecol. 1984; 64: 762–766.PubMedGoogle Scholar
  69. 69.
    Ledger WJ, Gee C, Lewis WP. Guidelines for antibiotic prophylaxis in gynecology. Am J Obstet Gynecol. 1975; 121: 1038–1045.PubMedGoogle Scholar
  70. 70.
    Ledger WJ. Prevention, diagnosis, and treatment of postoperative infections. Obstet Gynecol. 1980; 55(Suppl. 5): 203S–206S.PubMedGoogle Scholar
  71. 71.
    Lander JL, Steigrad SJ. Single dose preoperative prophylactic antibiotic in vaginal hysterectomy. Aust NZ J Obstet Gynaecol. 1978; 18: 73–75.CrossRefGoogle Scholar
  72. 72.
    Spruill FG, Minette LJ, Sturner WQ. Two surgical deaths associated with cephalothin. JAMA. 1974; 229: 440–441.PubMedCrossRefGoogle Scholar
  73. 73.
    Ledger WJ, Puttler OL. Death from pseudo-membranous enterocolitis. Obstet Gynecol. 1975; 45: 609–613.PubMedCrossRefGoogle Scholar
  74. 74.
    Tan J, Bayne LH, McLeod PJ. Pseudomembranous colitis. A fatal case following prophylactic cephaloridine therapy. JAMA. 1979; 242: 749–750.PubMedCrossRefGoogle Scholar
  75. 75.
    Hutcheon DF, Milligan FD, Yardley JH, et al. Cephalosporin-associated pseudomembranous colitis. Am J Dig Dis. 1978; 23: 321–326.PubMedCrossRefGoogle Scholar
  76. 76.
    Cuchural GJ Jr, Tally FP, Jacobus NV, et al. Antimicrobial susceptibilities of 1,292 isolates of the Bacteroides fragilis group in the United States: comparison of 1981 with 1982. Antimicrob Agents Chemother. 1984; 26: 145–148.PubMedGoogle Scholar
  77. 77.
    Guglielmo BJ, Hohn DC, Koo PJ, et al. Antibiotic prophylaxis in surgical procedures. A critical analysis of the literature. Arch Surg. 1983; 118: 943–955.PubMedGoogle Scholar

Copyright information

© Springer-Verlag New York Inc. 1986

Authors and Affiliations

  • David L. Hemsell

There are no affiliations available

Personalised recommendations