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López CC, Villegas-Echeverri JD, De Los Rios JF, Vásquez-Trespalacios EM, Arango A, Cifuentes C, Orjuela J, Valencia V, Cárdenas L, López JD, López JD, Zambrano CP, Gómez SM, Bastidas C, Silva JB, Gallego DE. Metronidazole for Prevention of Pelvic Cellulitis and Abscess after Laparoscopic Hysterectomy: A Triple-blinded, Randomized, Placebo-controlled Clinical Trial. J Minim Invasive Gynecol 2023; 30:912-918. [PMID: 37463650 DOI: 10.1016/j.jmig.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 07/02/2023] [Accepted: 07/07/2023] [Indexed: 07/20/2023]
Abstract
STUDY OBJECTIVE To determine whether a postoperative 5-day treatment schedule with vaginal metronidazole added to conventional antibiotic prophylaxis with 2 g cefazolin modifies the risk of pelvic cellulitis (PC) and pelvic abscess (PA) after total laparoscopic hysterectomy (TLH). DESIGN A randomized, controlled, triple-blind, multicenter clinical trial. SETTING Two centers dedicated to minimally invasive gynecologic surgery in Colombia. PATIENTS A total of 574 patients were taken to TLH because of benign diseases. INTERVENTION Patients taken to TLH were divided into 2 groups (treatment group, cefazolin 2 g intravenous single dose before surgery + metronidazole vaginal ovules for 5 days postoperatively, control group: cefazolin 2 g intravenous single dose + placebo vaginal ovules for 5 days postoperatively). MEASUREMENTS AND MAIN RESULTS The absolute frequency (AF) of PC and PA and their relationship with the presence of bacterial vaginosis (BV) were measured. There was no difference in AF of PC (AF, 2/285 [0.7%] vs 5/284 [1.7%] in the treatment and placebo groups, respectively; risk ratio, 1.75; 95% confidence interval, 0.54-5.65; p = .261), nor for PA (AF, 0/285 [0%] vs 2/289 [0.7%]; p = .159, in the treatment and placebo groups, respectively). The incidence of BV was higher in the metronidazole group than the placebo group (42.5% vs 33.4%, p = .026). CONCLUSION The use of vaginal metronidazole ovules during the first 5 days in postoperative TLH added to conventional cefazolin prophylaxis does not prevent the development of PC or PA, regardless of the patient's diagnosis of BV.
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Affiliation(s)
- Claudia C López
- Clínica del Prado (Drs. De Los Ríos, C. López, Arango, Cifuentes, Orjuela, and Gallego), Medellín, Colombia
| | | | - Jose F De Los Rios
- Clínica del Prado (Drs. De Los Ríos, C. López, Arango, Cifuentes, Orjuela, and Gallego), Medellín, Colombia
| | | | - Adriana Arango
- Clínica del Prado (Drs. De Los Ríos, C. López, Arango, Cifuentes, Orjuela, and Gallego), Medellín, Colombia
| | - Carolina Cifuentes
- Clínica del Prado (Drs. De Los Ríos, C. López, Arango, Cifuentes, Orjuela, and Gallego), Medellín, Colombia
| | - Jerutsa Orjuela
- Clínica del Prado (Drs. De Los Ríos, C. López, Arango, Cifuentes, Orjuela, and Gallego), Medellín, Colombia
| | - Victor Valencia
- Facultad de Medicina (Drs. Valencia, Cárdenas, Bareño, Gómez, and Vásquez), Universidad CES, Medellín, Colombia
| | - Lina Cárdenas
- Facultad de Medicina (Drs. Valencia, Cárdenas, Bareño, Gómez, and Vásquez), Universidad CES, Medellín, Colombia
| | - José Duvan López
- Unidad Algia (Drs. Villegas, J. López, J. López, Zambrano, and Bastidas)
| | - Jorge Darío López
- Unidad Algia (Drs. Villegas, J. López, J. López, Zambrano, and Bastidas)
| | - Claudia P Zambrano
- Unidad Algia (Drs. Villegas, J. López, J. López, Zambrano, and Bastidas)
| | - Sandra M Gómez
- Facultad de Medicina (Drs. Valencia, Cárdenas, Bareño, Gómez, and Vásquez), Universidad CES, Medellín, Colombia
| | - Claudia Bastidas
- Unidad Algia (Drs. Villegas, J. López, J. López, Zambrano, and Bastidas)
| | - Jose Bareño Silva
- Facultad de Medicina (Drs. Valencia, Cárdenas, Bareño, Gómez, and Vásquez), Universidad CES, Medellín, Colombia
| | - Diego E Gallego
- Clínica del Prado (Drs. De Los Ríos, C. López, Arango, Cifuentes, Orjuela, and Gallego), Medellín, Colombia.
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Song N, Gao M, Tian J, Gao Y. Choice for prophylactic antibiotics: Cefazolin plus metronidazole or cefoxitin alone for endometrial cancer surgical staging. J Obstet Gynaecol Res 2020; 46:1864-1870. [PMID: 32558128 DOI: 10.1111/jog.14348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/14/2020] [Accepted: 05/23/2020] [Indexed: 11/29/2022]
Abstract
AIM The use of prophylactic antibiotics has greatly reduced the incidence of surgical site infections after hysterectomy. It is worth discussing which antibiotic is better. The purpose of this study was to investigate the role of the combined utilization of cefazolin and metronidazole for the prevention of surgical site infection in laparoscopic staging surgery of endometrial cancer. METHODS A retrospective analysis was performed on the incidence of surgical site infection in patients with endometrial cancer who underwent laparoscopic surgical staging from January 2000 to June 2019 within 1 month after surgery. Logistic regression model was used for univariate and multivariate analysis. RESULTS A total of 1783 patients were included in this study, of which 641 were treated with cefazoline plus metronidazole (group 1) as a prophylactic antibiotic, while the other 1142 were treated with cefoxitin (group 2). There was no difference in clinical characteristics between the two groups. The rates of surgical site infection in groups 1 and 2 were 3.6% (n = 23) and 5.7% (n = 65), respectively. The most common site of infections was vaginal, with the incidence of 1.7% (n = 11) and 3.3% (n = 38) in groups 1 and 2, respectively. The multivariate analysis disclosed that cefazoline plus metronidazole significantly reduced the incidence of surgical site infections compared with cefoxitin (logistic, odds ratio = 2.213, 95% confidence interval 1.193 to 4.107). CONCLUSION Cefazolin plus metronidazole as prophylactic antibiotics for surgical staging of endometrial cancer can more effectively reduce the incidence of surgical site infections than cefoxitin.
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Affiliation(s)
- Nan Song
- Department of Gynecology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Min Gao
- Department of Gynecology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Juan Tian
- Department of Gynecology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Yunong Gao
- Department of Gynecology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
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Gil-Conesa M, Del-Moral-Luque JA, Climent-Martínez N, Delgado-Iribarren A, Riera-Pérez R, Martín-Caballero C, Campello-Gutiérrez C, Durán-Poveda M, Rodríguez-Caravaca G, Gil-de-Miguel A, Rodríguez-Villar D. [Evaluation of compliance with the antibiotic prophylaxis protocol in hysterectomy. Prospective cohort study]. REVISTA ESPANOLA DE QUIMIOTERAPIA 2020; 33:180-186. [PMID: 32232318 PMCID: PMC7262387 DOI: 10.37201/req/098.2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objetivo Las infecciones relacionadas con la asistencia sanitaria (IRAS) son un problema de salud pública, siendo las infecciones de localización quirúrgica (ILQ) las más frecuentes a nivel hospitalario. El objetivo de este estudio fue evaluar el efecto de la adecuación de la profilaxis antibiótica en la incidencia de infección quirúrgica en pacientes histerectomizadas. Material y métodos Se realizó un estudio de cohortes prospectivo entre octubre de 2009 y diciembre de 2018. Se estudió la incidencia de ILQ durante los primeros 30 días tras la cirugía. Se evaluó el grado de adecuación de la profilaxis antibiótica en histerectomía y el efecto de su inadecuación en la incidencia de infección con el riesgo relativo (RR) ajustado mediante un modelo de regresión logística. Resultados Se estudiaron 1.025 intervenciones en 1.022 mujeres. La incidencia acumulada de ILQ fue del 2,1% (n=22) y la etiología más frecuente Escherichia coli (23,1%) y Proteus mirabilis (23,1%). La profilaxis antibiótica estaba indicada en 1.014 intervenciones (98,9%) administrándose en 1.009 de ellas (99,5%), con una adecuación general al protocolo del 92,5%. La causa principal de no cumplimiento fue el tiempo de inicio (40,9%), seguida por la elección del antibiótico (35,2%). El efecto de la inadecuación de la profilaxis sobre la incidencia de infección fue de RR=0,9; IC95% 0,2-3,9; p>0,05. Conclusiones La adecuación de la profilaxis antibiótica fue muy alta, con una baja incidencia de infección quirúrgica. No se encontró asociación entre adecuación de la profilaxis e incidencia de infección en histerectomía. Se debe insistir en la mejora continua de la vigilancia epidemiológica en ginecología.
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Affiliation(s)
| | | | | | | | | | | | | | | | - G Rodríguez-Caravaca
- Gil Rodríguez-Caravaca, Unidad de Medicina Preventiva, Hospital Universitario Fundación Alcorcón C/ Budapest 1, 28922 Alcorcón (Madrid). Spain.
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