Evaluation of antimicrobial prophylaxis in genital gender affirmation surgery

The purpose of this study was to evaluate antimicrobial prophylaxis regimens for genital gender affirmation surgery in the prevention of surgical site infections and other infectious complications and to provide a descriptive report of what was observed when using the study sites' recommended regimens.

This retrospective observational study was completed at 2 urban academic medical centers between June 1, 2020, and June 30, 2023. All data were collected through retrospective chart review. The primary outcome of this study was the prevalence of surgical site infections within 30 days following genital gender affirmation surgery completed by a single surgeon at 2 health centers. Secondary outcomes included the prevalence of surgical site infections within 6 months of surgery, potential relationships of demographic data and type of surgery with the development of postoperative infection, and relationships of antibiotics, dose, and number of subsequent doses with the development of postoperative infection.

A total of 146 surgeries (124 patients) were included in the final analysis. Surgical site infection occurred within 30 days postoperatively in 4 patients (3%), most commonly noted on the first follow-up visit within 1 month of surgery. Another 2 infections occurred within 6 months postoperatively, resulting in a total of 6 patients (4%) with surgical site infections during the study period.

This study observed an acceptable prevalence of surgical site infections within both 30 days and 6 months of genital gender affirmation surgery. This outcome supports the use of narrow gram-positive and gram-negative coverage (ie, cefazolin) for clean and clean-contaminated procedures without entry into the gastrointestinal (GI) or gastroduodenal (GU) tracts, with the addition of anaerobic coverage (ie, metronidazole) for clean-contaminated procedures with entry into the GI or GU tract, as clinically appropriate options.