Infection after radical abdominal hysterectomy and pelvic lymphadenectomy: prevention of infection with a two-dose peri-operative antibiotic prophylaxis

Abstract

Surgical site-related infections occurred in 21% of 87 consecutive patients undergoing radical hysterectomy with pelvic lymphadenectomy (RHPL) without planned peri-operative prophylaxis. A prospective, randomized double-blind, placebo-controlled study was conducted in 68 consecutive RHPL patients. In the 32 available patients with two-dose cefuroxime and metronidazole prophylaxis no surgical site-related infections developed as opposed to a rate of 14% in the 28 patients in the placebo group (P< 0.05). In a prospective, randomized double-blind study two two-dose antibiotic prophylactic regimens were compared in 105 consecutive patients. Surgical site-related infections developed in one (2%) patient in the cefuroxime plus metronidazole group, and in six (12%) patients in the moxalactam group. This difference did not achieve statistical significance. The mean length of the postoperative hospital stay of the patients with scheduled surgical prophylaxis was significantly shorter (P< 0.01) than that of the patients operated on without surgical prophylaxis. A two-dose antibiotic regimen is recommended, because levels of antibiotics assayed in samples collected during the course of the operation indicated a rapid clearance of the antibiotics from the operative site, most likely due to the high volume of peri-operative blood loss.