Intraoperative wound contamination during abdominal hysterectomy

Area of Science:

• Surgical Infectious Disease
• Microbiology
• Gynecologic Surgery

Background:

• Qualitative bacterial cultures are insufficient for predicting postoperative infections after abdominal hysterectomy.
• Understanding the relationship between bacterial contamination levels and infection risk is crucial for effective prevention strategies.

Purpose of the Study:

• To investigate the correlation between the magnitude of intraoperative pelvic fluid bacterial contamination and the incidence of postoperative infectious morbidity following abdominal hysterectomy.
• To compare the efficacy of cefotetan versus ampicillin-plus-metronidazole chemoprophylaxis in relation to bacterial contamination levels.

Main Methods:

• Quantitative bacterial culture of intraoperative pelvic fluid samples from 163 women undergoing abdominal hysterectomy, including 40 without chemoprophylaxis.
• Analysis of anaerobic, aerobic, and microaerophilic bacteria counts.
• Correlation of bacterial counts with postoperative infectious morbidity (wound infection, febrile morbidity) using step-up multiple logistic regression.

Main Results:

• Total and microaerophilic bacterial counts were significant predictors of postoperative infectious morbidity.
• Patients with total bacterial counts >= 10(4) cfu/ml had a 42.5% incidence of infectious morbidity, compared to 12.6% for those with counts <= 10(3) cfu/ml.
• Anaerobes and microaerophiles were common contaminants, consistent with vaginal and skin flora.

Conclusions:

• The magnitude of bacterial contamination during abdominal hysterectomy is a critical determinant of postoperative infectious morbidity.
• Quantitative bacterial assessment can identify patients at higher risk for infection.