Antibiotic prophylaxis for elective hysterectomy.

Area of Science:

• Gynecological Surgery
• Infectious Disease Prevention
• Evidence-Based Medicine

Background:

• Elective hysterectomy is a common procedure for benign gynecological conditions.
• Postoperative infection rates are significant, particularly after vaginal hysterectomy (40%-50%) and abdominal hysterectomy (>20%).
• Systematic evidence on antibiotic prophylaxis for hysterectomy was lacking.

Purpose of the Study:

• To evaluate the effectiveness and safety of antibiotic prophylaxis in women undergoing elective hysterectomy.

Main Methods:

• Systematic review of 37 randomized controlled trials (RCTs) involving 6079 women.
• Searched multiple electronic databases up to November 2016.
• Included RCTs comparing antibiotics versus placebo or other antibiotics.

Main Results:

• Antibiotic prophylaxis significantly reduced total postoperative infections, urinary tract infections, pelvic infections, and fevers for both vaginal and abdominal hysterectomy.
• For vaginal hysterectomy, infection risk decreased from ~34% to 7%-14%; for abdominal hysterectomy, from ~16% to 1%-6%.
• Evidence on specific antibiotic comparisons, optimal regimens, and adverse effects was limited or insufficient.

Conclusions:

• Antibiotic prophylaxis is effective in preventing postoperative infections after elective hysterectomy.
• Insufficient evidence exists to determine the optimal antibiotic, dose, or route, or to assess effects on adverse events.
• Study findings may not reflect current practices due to the age of the included studies.