Antibiotic prophylaxis in diagnostic hysteroscopy: is it necessary or not?

Surgical site infection remains the most common complication of surgery. Up to 5% of patients undergoing operative procedures will develop an infection leading to a prolonged hospital stay with increased cost. On the other hand the indiscriminate use of antibiotics has been associated with the development of antibiotic-resistant bacteria. The aim of this study was to examine the effect of antibiotic prophylaxis in cases of diagnostic hysteroscopy.

This was an eight-year randomized controlled clinical trial. The study group consisted of 364 women who underwent diagnostic hysteroscopy because of menometrorrhagia, post-menopausal vaginal bleeding, ultrasound findings of increased thickness of the endometrium, or as a routine examination prior to a first in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatment.

Of the 364 women who underwent diagnostic hysteroscopy during this eight-year study period, 176 received antibiotic prophylaxis whereas 188 did not. There were no significant differences in the prevalence of postoperative infections observed between women who received antibiotic prophylaxis (0.57%) and those who underwent the procedure without prophylaxis (0.53%).

Given the very low risk of infection after diagnostic hysteroscopy and lack of evidence of efficacy, routine antibiotic prophylaxis is not recommended.