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Does additional anaerobic coverage improve surgical site infection prophylaxis in elective hysterectomy: A systematic
Hailey Penny1, Keiko Patterson1, Claire Connors1
1Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary.
Background:
Surgical site infections (SSIs) remain one of the most common healthcare-associated infections. The SOGC recommends antimicrobial prophylaxis with a first- or second-generation cephalosporin for elective hysterectomy. In some centers, metronidazole is additionally used to provide both aerobic and anaerobic coverage. However, evidence is lacking to support this. This review assessed whether the addition of an anti-anaerobic antibiotic to a first- or second-generation cephalosporin reduces rates of SSIs following elective hysterectomy for benign indications.
Methods:
This systematic review was conducted in accordance with the PRISMA 2020 checklist and registered with Prospero. Study eligibility criteria included those with (1) participants >18-year-old undergoing elective hysterectomy for benign indications; (2) anti-anaerobic antibiotic combined with a first- or second-generation cephalosporin compared with these cephalosporins alone; (3) rate of SSIs. MEDLINE, OVID, and Web of Science were searched with literature extending into August 2024. Meta-analysis was conducted using R Statistical Software.
Results:
The search identified 275 studies. Four met eligibility criteria (2 RCTs, 1 prospective cohort study, and 1 retrospective cohort study). Sample sizes ranged from 46-4271 participants. Rate of SSIs among the intervention and control groups ranged from 2.4-17.4% and 4.4-21.7%, respectively. Two studies demonstrated reduced SSIs with the addition of an anti-anaerobic antibiotic; none achieved statistical significance. The meta-analysis summary estimate demonstrated no statistical significance between the intervention and control groups (RR 0.95; 95% CI 0.76-1.20; P = 0.47). Using ROB2 tool for randomized control trials (RCTs) and ROBIN-I tool for observational studies, three of the four studies demonstrated a moderate-to-high risk of bias.
Conclusions:
Based on the available evidence, the addition of anaerobic coverage has no statistically significant impact on SSI rates following elective hysterectomy. Additional rigorous and adequately powered studies are required.
