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Ribero L, Santía MC, Borchardt K, Zabaneh F, Beck A, Sadhu A, Edwards K, Harrelson M, Pinales-Rodriguez A, Yates EM, Ramirez PT. Surgical site infection prevention bundle in gynecology oncology surgery: a key element in the implementation of an enhanced recovery after surgery (ERAS) program. Int J Gynecol Cancer 2024:ijgc-2024-005423. [PMID: 38876786 DOI: 10.1136/ijgc-2024-005423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2024] Open
Abstract
Surgical site infection rates are among 5-35% in all gynecologic oncology procedures. Such infections lead to increased patient morbidity, reduction in quality of life, higher likelihood of readmissions, and reinterventions, which contribute directly to mortality and increase in health-related costs. Some of these are potentially preventable by applying evidence-based strategies in the peri-operative patient setting. The objective of this review is to provide recommendations for the individual components that most commonly comprise the surgical site infection prevention bundles that could be implemented in gynecologic oncology procedures. We searched articles from relevant publications with specific topics related to each surgical site infection intervention chosen to be reviewed. Studies on each topic were selected with an emphasis on meta-analyses, systematic reviews, randomized control studies, non-randomized controlled studies, reviews, clinical practice guidelines, and case series. Data synthesis was done through content and thematic analysis to identify key themes in the included studies. This review intends to serve as the most up-to-date frame of evidence-based peri-operative care in our specialty and could serve as the first initiative to introduce an enhanced recovery after surgery (ERAS) program.
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Affiliation(s)
- Lucia Ribero
- Division of Gynecologic Surgery, European Institute of Oncology, Milan, Italy
| | - María Clara Santía
- Department of Obstetrics and Gynecology, Houston Methodist Hospital Neal Cancer Center, Houston, Texas, USA
| | - Kathleen Borchardt
- Department of Obstetrics and Gynecology, Houston Methodist Hospital Neal Cancer Center, Houston, Texas, USA
| | - Firaz Zabaneh
- Department of System Infection Control, Houston Methodist Hospital, Houston, Texas, USA
| | - Amanda Beck
- Department of Pharmacy, Houston Methodist Hospital, Houston, Texas, USA
| | - Archana Sadhu
- Department of Endocrinology, Houston Methodist Hospital, Houston, Texas, USA
| | - Karen Edwards
- Department of Obstetrics and Gynecology, Houston Methodist Hospital Neal Cancer Center, Houston, Texas, USA
| | - Monica Harrelson
- Department of Obstetrics and Gynecology, Houston Methodist Hospital Neal Cancer Center, Houston, Texas, USA
| | - Aimee Pinales-Rodriguez
- Department of Obstetrics and Gynecology, Houston Methodist Hospital Neal Cancer Center, Houston, Texas, USA
| | - Elise Mann Yates
- Department of Obstetrics and Gynecology, Houston Methodist Hospital Neal Cancer Center, Houston, Texas, USA
| | - Pedro T Ramirez
- Department of Obstetrics and Gynecology, Houston Methodist Hospital Neal Cancer Center, Houston, Texas, USA
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Meyer R, Niino C, Schneyer R, Hamilton K, Siedhoff MT, Wright KN. Surgical Field Separation in Total Laparoscopic Hysterectomy. Obstet Gynecol 2024:00006250-990000000-01064. [PMID: 38696813 DOI: 10.1097/aog.0000000000005596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/14/2024] [Indexed: 05/04/2024]
Abstract
We aimed to study whether separating the vaginal and abdominal surgical fields during total laparoscopic hysterectomy (TLH) is associated with surgical site infection rates. This was a retrospective cohort study of all patients who underwent TLH and any concomitant procedures with two minimally invasive gynecologic surgery subspecialists between January 2016 and May 2023. Among 680 included patients, the rate of infection was 0.8% with surgical field separation and 1.3% without (3/377 vs 4/303; odds ratio 0.60, 95% CI, 0.13-2.70). There was no statistical difference between groups; however, the difference in infection rates between groups was extremely small, which led to inadequate power. Our findings suggest that rates of infection after TLH are low, with or without surgical field separation. Treating the vagina, perineum, and abdomen as a single, continuous operative field during TLH may be an acceptable practice.
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Affiliation(s)
- Raanan Meyer
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, and the Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
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Khalfay N, Markovic D, Holschneider C, Dejbakhsh S, Escher K, Han M. The Role of Preoperative Antibiotics in Surgical Site Infection (SSI) Rate after Class I/Clean Gynaecologic Surgery at an Academic Safety Net Hospital. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102404. [PMID: 38336006 DOI: 10.1016/j.jogc.2024.102404] [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: 12/01/2023] [Revised: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVES Examine whether preoperative antibiotics in class I/clean abdominal gynaecologic surgery decrease the incidence of surgical site infections (SSI). METHODS Retrospective cohort study at academic safety net hospital of patients undergoing class I laparoscopic or open gynaecologic surgery between November 2013 and September 2017. Performance improvement initiative to administer preoperative antibiotics to all surgical patients starting July 2016. RESULTS In total, 510 patients were included: 283 in the antibiotic group and 227 in the no-antibiotic group. PRIMARY OUTCOME incidence of SSI. Baseline characteristics were similar between groups once balanced by propensity score method. In unweighted analysis, incidence of SSI decreased from 9.3% (21/227) in the no-antibiotics group to 4.9% (14/283) in antibiotics group, but this was not statistically significant (odds ratio (OR) 0.51 CI 0.25-1.03, P = 0.0598). Following of inverse probability of treatment weighting adjustments in weighted analysis, incidence of SSI was found to be significantly lower in patients who received antibiotics compared to patients who did not receive antibiotics across entry types (4.6% vs. 9.8%, OR 0.45; CI 0.22-0.90, P = 0.023). Weighted analysis demonstrated in the exploratory laparotomy group patients who received antibiotics had a lower incidence of SSI compared to patients who did not receive antibiotics (5.1% vs. 18.7%, OR 0.23; CI 0.08-0.68, P = 0.008). In the laparoscopy group, there was no difference between groups (4.4% vs. 5.4%, OR 0.81; CI 0.3-2.16, P = 0.675). CONCLUSIONS There is limited literature on SSI prevention/preoperative antibiotic use in class I gynaecologic surgeries. This study demonstrates antibiotics in class I procedures decrease SSI rates, specifically in open procedures. There was a lack of demonstrated benefit in laparoscopy.
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Affiliation(s)
- Nuha Khalfay
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Daniela Markovic
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; UCLA Department of Medicine Statistics Core, Los Angeles, CA, USA
| | - Christine Holschneider
- David Geffen School of Medicine at UCLA, Department of Obstetrics and Gynecology, Olive View UCLA Medical Center, Los Angeles, CA, USA
| | | | - Kirin Escher
- Department of Family Medicine, Martin Luther King Hospital, Los Angeles, CA, USA
| | - Michelle Han
- David Geffen School of Medicine at UCLA, Department of Obstetrics and Gynecology, Olive View UCLA Medical Center, Los Angeles, CA, USA.
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Cromack SC, Yu L, Milad MP. Prostaglandin Injection for Myoma Expulsion (PRIME): Case Series of a Novel Approach to Hysteroscopic Resection of FIGO Type 2 Myomas. J Minim Invasive Gynecol 2024:S1553-4650(24)00157-2. [PMID: 38604533 DOI: 10.1016/j.jmig.2024.03.011] [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: 02/18/2024] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/13/2024]
Abstract
STUDY OBJECTIVE To evaluate the use of dilute carboprost tromethamine injection at the endometrium/myoma junction during hysteroscopy to facilitate myoma expulsion and removal in a single procedure. DESIGN Case series. SETTING Single high-volume academic medical center. PATIENTS Seven patients aged 32 to 51 years old with FIGO type 2 uterine myomas and symptoms of abnormal uterine bleeding or infertility undergoing hysteroscopic resection with a morcellation device from November 2022 to July 2023. INTERVENTION Dilute injection of carboprost tromethamine (10 µg/mL) at time of hysteroscopic myomectomy. MEASUREMENTS AND MAIN RESULTS The main outcome measure was ability to complete the hysteroscopic myomectomy in a single procedure using a hysteroscopic morcellator. Secondary outcomes included total operative time, fluid deficit, and postoperative pharmacologic side effects and/or surgical complications. Among our 7 patients, all had successful single procedure complete resections of myomas ranging from 0.9 to 4.6 cm in maximal diameter. Average operative time was 30 minutes, and average fluid deficit was approximately 839 mL. The carboprost dosages used ranged from 30 to 180 µg. One patient experienced prolonged postoperative nausea and vomiting that resolved with antiemetics. One patient experienced postoperative endometritis that improved with antibiotics. CONCLUSION In this pilot study, injection of dilute carboprost intraoperatively facilitated one-step hysteroscopic myomectomy of FIGO 2 myomas, via enhanced extrusion of the intramural portion of the fibroid into the uterine cavity, with both short operative times and acceptable fluid deficits.
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Affiliation(s)
- Sarah C Cromack
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, Northwestern Feinberg School of Medicine (Dr. Cromack), Chicago, Illinois.
| | - Lulu Yu
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics & Gynecology, Northwestern Feinberg School of Medicine (Drs. Yu and Milad), Chicago, Illinois
| | - Magdy P Milad
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics & Gynecology, Northwestern Feinberg School of Medicine (Drs. Yu and Milad), Chicago, Illinois
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Knisely A, Iniesta MD, Marten CA, Chisholm G, Schmeler KM, Taylor JS. Metronidazole and cefazolin vs cefazolin alone for surgical site infection prophylaxis in gynecologic surgery at a comprehensive cancer center. Am J Obstet Gynecol 2024:S0002-9378(24)00507-6. [PMID: 38599478 DOI: 10.1016/j.ajog.2024.03.043] [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: 01/15/2024] [Revised: 03/21/2024] [Accepted: 03/24/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Surgical site infection is one of the most common complications of gynecologic cancer surgery. Current guidelines recommend the administration of cefazolin preoperatively to reduce surgical site infection rates for patients undergoing clean-contaminated surgeries such as hysterectomy. OBJECTIVE To evaluate the impact of a quality improvement project adding metronidazole to cefazolin for antibiotic prophylaxis on surgical site infection rate for women undergoing gynecologic surgery at a comprehensive cancer center. STUDY DESIGN This retrospective, single-center cohort study included patients who underwent surgery in the gynecologic oncology department from May 2017 to June 2023. Patients with penicillin allergies and those undergoing concomitant bowel resections and/or joint cases were excluded. The preintervention group patients had surgery from May 2017 to April 2022, and the postintervention group patients had surgery from April 2022 to June 2023. The primary outcome was a 30-day surgical site infection rate. Sensitivity analyses were performed to compare surgical site infection rates on the basis of actual antibiotics received and for those who had a hysterectomy. Factors independently associated with surgical site infection were identified using a multivariable logistic regression model adjusting for confounding variables. RESULTS Of 3343 patients, 2572 (76.9%) and 771 (23.1%) were in the pre-post intervention groups, respectively. Most patients (74.7%) had a hysterectomy performed. Thirty-four percent of cases were for nononcologic (benign) indications. Preintervention patients were more likely to receive appropriate preoperative antibiotics (95.6% vs 90.7%; P<.001). The overall surgical site infection rate before the intervention was 4.7% compared with 2.6% after (P=.010). The surgical site infection rate for all patients who underwent hysterectomy was 4.9% (preintervention) vs 2.8% (postintervention) (P=.036); a similar trend was seen for benign cases (4.4% vs 2.4%; P=.159). On multivariable analysis, the odds ratio for surgical site infection was 0.49 (95% confidence interval, 0.38-0.63) for the postintervention compared with the preintervention group (P<.001). In a sensitivity analysis (n=3087), the surgical site infection rate was 4.5% for those who received cefazolin alone compared with 2.3% for those who received cefazolin plus metronidazole, with significantly decreased odds of surgical site infection for the cefazolin plus metronidazole group (adjusted odds ratio, 0.40 [95% confidence interval, 0.30-0.53]; P<.001). Among only those who had a hysterectomy performed, the odds of surgical site infection were significantly reduced for those in the postintervention group (adjusted odds ratio, 0.63 [95% confidence interval, 0.47-0.86]; P=.003). CONCLUSION The addition of metronidazole to cefazolin before gynecologic surgery decreased the surgical site infection rate by half, even after accounting for other known predictors of surgical site infection and differences in practice patterns over time. Providers should consider this combination regimen in women undergoing gynecologic surgery, especially for cases involving hysterectomy.
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Affiliation(s)
- Anne Knisely
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Maria D Iniesta
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Claire A Marten
- Division of Pharmacy, Department of Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gary Chisholm
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kathleen M Schmeler
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jolyn S Taylor
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
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Pradhan T, Zhang H, Kadesh A, Buskwofie A, Patankar S, Menon S, Ryntz T, Grimes CL. PROJECT PREVENT: a randomized controlled trial of preoperative vaginal metronidazole to decrease patient issues and infections after hysterectomy. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2024; 6:e000241. [PMID: 38596254 PMCID: PMC11002362 DOI: 10.1136/bmjsit-2023-000241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/20/2024] [Indexed: 04/11/2024] Open
Abstract
Objectives To evaluate if vaginal metronidazole for 5 days before hysterectomy decreases postoperative infections and patient issues. Design This randomized trial compared vaginal metronidazole for 5 days before a scheduled hysterectomy to no intervention. Sample size calculation was based on a 20% difference in issues and infection (30% incidence and 10% in the intervention arm) with 80% power and an alpha error of 0.05 and indicated 62 subjects needed in each arm. Setting Outpatient gynecology clinics at a single academic institution. Participants 154 subjects were screened for eligibility between July 2020 and September 2022. 133 underwent hysterectomy including 68 subjects (51.1%) randomized to the metronidazole and 65 (48.9%) controls. Overall, the population was racially and ethnically diverse. There was no significant difference in characteristics between the two groups. Interventions Vaginal metronidazole for 5 days before hysterectomy. Main outcome measures Postoperative patient issues and documented postoperative infections at 4-8 weeks after surgery. Results There was no difference in the composite rate of patient-reported issues and/or documented postoperative infection (53/133 (39.8%) with no difference between groups (29/68 (42.6%) vs 24/65 (36.9%), p=0.50). There was no difference in patient-reported issues which was 51/133 (38.3%) with no difference between groups (28/68 (41.2%) vs 23/65 (33.8%), p=0.49) or in documented infections with a rate of 25/133 (18.8%) with no significant difference between groups (15/68 (22.0%) vs 10/65 (15.4%), p=0.33). In the intervention arm, the compliance rate was 73.5% for all 5 days of vaginal metronidazole, and a per-protocol analysis was performed which resulted in no significant difference between groups. Conclusions There is insufficient evidence to suggest a significant benefit of preoperative vaginal metronidazole to prevent surgical site infections and postoperative patient issues in patients undergoing hysterectomy. Trial registration number ClinicalTrials.gov, NCT04478617.
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Affiliation(s)
- Tana Pradhan
- Obstetrics and Gynecology, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - Helen Zhang
- Obstetrics and Gynecology, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - Amanda Kadesh
- Obstetrics and Gynecology, Jefferson Abington Hospital, Abington, Pennsylvania, USA
| | - Ama Buskwofie
- Obstetrics and Gynecology, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - Sonali Patankar
- Obstetrics and Gynecology, RWJ Barnabas Health, New Brunswick, New Jersey, USA
| | - Sharifa Menon
- Obstetrics and Gynecology, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - Timothy Ryntz
- Obstetrics and Gynecology, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - Cara L. Grimes
- Obstetrics and Gynecology, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
- Urology, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
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7
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Benseler A, Tomlinson G, Lovatsis D, Alarab M, McDermott CD. Optimizing practices to prevent urinary tract infection after cystoscopy and urodynamics in women: A quality improvement study. Neurourol Urodyn 2024; 43:883-892. [PMID: 38501377 DOI: 10.1002/nau.25447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 01/28/2024] [Accepted: 03/09/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE The objective of this study was to reduce the incidence of urinary tract infection (UTI) in women undergoing outpatient cystoscopy and/or urodynamic studies (UDS) at our centre by identifying and then altering modifiable risk factors through an analysis of incidence variability among physicians. METHODS This was a quality improvement study involving adult women undergoing outpatient cystoscopy and/or UDS at an academic tertiary urogynecology practice. Prophylactic practices for cystoscopy/UDS were surveyed and division and physician-specific UTI rates following cystoscopy/UDS were established. In consultation with key stakeholders, this delineated change concepts based on associations between prophylactic practices and UTI incidence, which were then implemented while monitoring counterbalance measures. RESULTS Two "Plan-Do-Study-Act-Cycles" were conducted whereby 212 and 210 women were recruited, respectively. Change concepts developed and implemented were: (1) to perform routine urine cultures at the time of these outpatient procedures, and (2) to withhold routine prophylactic antibiotics for outpatient cystoscopy/UDS, except in patients with signs of cystitis. There was no change in the incidence of early presenting UTI (9.0% vs. 9.2%, p = 0.680), but there were significantly fewer antibiotic-related adverse events reported (8.5% vs. 1.5%, p = 0.001). There was no significant change in the total incidence of UTI rates between cycles (7.8% vs. 5.6%, p = 0.649). CONCLUSIONS No specific strategies to decrease the incidence of UTI following outpatient cystoscopy/UDS were identified, however, risk factor-specific antibiotic prophylaxis, as opposed to universal antibiotic prophylaxis, did not increase UTI incidence.
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Affiliation(s)
- Anouk Benseler
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - George Tomlinson
- Department of Medicine, University Health Network and Mount Sinai Hospital; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Danny Lovatsis
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
- Division of Urogynecology, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - May Alarab
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
- Division of Urogynecology, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Colleen D McDermott
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
- Division of Urogynecology, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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Dutra KJ, Lazenby GB, Goje O, Soper DE. Cefazolin as the mainstay for antibiotic prophylaxis in patients with a penicillin allergy in obstetrics and gynecology. Am J Obstet Gynecol 2024:S0002-9378(24)00448-4. [PMID: 38527607 DOI: 10.1016/j.ajog.2024.03.019] [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: 11/16/2023] [Revised: 02/20/2024] [Accepted: 03/13/2024] [Indexed: 03/27/2024]
Abstract
Cefazolin is the most common antibiotic used for prophylaxis in obstetrics and gynecology. Among those with a penicillin allergy, alternative antibiotics are often chosen for prophylaxis, given fears of cross-reactivity between penicillin and cefazolin. Alternative antibiotics in this setting are associated with adverse sequelae, including surgical site infection, induction of bacterial resistance, higher costs to the healthcare system, and possible Clostridium difficile infection. Given the difference in R1 side chains between penicillin and cefazolin, cefazolin use is safe and should be recommended for patients with a penicillin allergy, including those who experience Immunoglobulin E-mediated reactions such as anaphylaxis. Cefazolin should only be avoided in those who experience a history of a severe, life-threatening delayed hypersensitivity reaction manifested as severe cutaneous adverse reactions (Steven-Johnson Syndrome), hepatitis, nephritis, serum sickness, and hemolytic anemia in response to penicillin administration. In addition, >90% of those with a documented penicillin allergy do not have true allergies on skin testing. Increased referral for penicillin allergy testing should be incorporated into routine obstetric care and preoperative assessment to reduce suboptimal antibiotic prophylaxis use. More education is needed among providers surrounding penicillin allergy assessment and cross-reactivity among penicillins and cephalosporins to optimize antibiotic prophylaxis in obstetrics and gynecology.
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Affiliation(s)
- Karley J Dutra
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC.
| | - Gweneth B Lazenby
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC
| | - Oluwatosin Goje
- Department of Subspecialties, Obstetrics and Gynecology Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - David E Soper
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC
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Baïli S, Vereeck S, Jacquemyn Y. Salmonella hvittingfoss, a rare case of postoperative endometritis: A case report and review of the literature. Clin Case Rep 2024; 12:e8591. [PMID: 38505480 PMCID: PMC10948367 DOI: 10.1002/ccr3.8591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 02/06/2024] [Accepted: 02/22/2024] [Indexed: 03/21/2024] Open
Abstract
Key clinical message Microbiological diagnosis of endometritis and appropriate antibiotic treatment based on the antibiogram is essential. We should remain critical about the potential etiologic pathogens, especially when traveling abroad and during pregnancy. Therefore, it is essential to obtain cultures prior to the administration of antibiotics. Abstract We present a case of postoperative endometritis in a patient with incomplete miscarriage, who underwent dilatation and curettage. Blood, cervical and stool cultures revealed the presence of Salmonella hvittingfoss. Gynecological postoperative infections with Salmonella spp. are rare according to the current literature.
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Affiliation(s)
- Sarah Baïli
- Department of Obstetrics and GynaecologyAntwerp University Hospital UZA, Edegem Belgium and Antwerp University UA, ASRARC and Global Health InstituteAntwerpBelgium
| | - Sascha Vereeck
- Department of Obstetrics and GynaecologyAntwerp University Hospital UZA, Edegem Belgium and Antwerp University UA, ASRARC and Global Health InstituteAntwerpBelgium
| | - Yves Jacquemyn
- Department of Obstetrics and GynaecologyAntwerp University Hospital UZA, Edegem Belgium and Antwerp University UA, ASRARC and Global Health InstituteAntwerpBelgium
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Motan T, Cockwell H, Elliott J, Antaki R. Guideline No. 446: Hysteroscopic Surgery in Fertility Therapy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102400. [PMID: 38320665 DOI: 10.1016/j.jogc.2024.102400] [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] [Indexed: 02/08/2024]
Abstract
OBJECTIVE To evaluate the indications, benefits, and risks of hysteroscopy in the management of patients with infertility and provide guidance to gynaecologists who manage common conditions in these patients. TARGET POPULATION Patients with infertility (inability to conceive after 12 months of unprotected intercourse) undergoing investigation and treatment. BENEFITS, HARMS, AND COSTS Hysteroscopic surgery can be used to diagnose the etiology of infertility and improve fertility treatment outcomes. All surgery has risks and associated complications. Hysteroscopic surgery may not always improve fertility outcomes. All procedures have costs, which are borne either by the patient or their health insurance provider. EVIDENCE We searched English-language articles from January 2010 to May 2021 in PubMed/MEDLINE, Embase, Science Direct, Scopus, and Cochrane Library (see Appendix B for MeSH search terms). VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional recommendations). INTENDED AUDIENCE Gynaecologists who manage common conditions in patients with infertility. TWEETABLE ABSTRACT When offering hysteroscopic surgery to patients with infertility, ensure it improves the live birth rate. SUMMARY STATEMENTS RECOMMENDATIONS.
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Liu L, Jian Z, Wang M, Yuan C, Li Y, Ma Y, Jin X, Li H, He Y, Liu C, Li S, Wang K. Is antibiotic prophylaxis generally safe and effective in surgical and nonsurgical scenarios? Evidence from an umbrella review of randomized controlled trials. Int J Surg 2024; 110:1224-1233. [PMID: 38016138 PMCID: PMC10871558 DOI: 10.1097/js9.0000000000000923] [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: 09/07/2023] [Accepted: 11/09/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND The authors aimed to comprehensively evaluate the efficacy and safety of antibiotic prophylaxis through surgical and nonsurgical scenarios and assess the strength of evidence. MATERIALS AND METHODS The authors performed an umbrella review of meta-analyses of randomized controlled trials (RCTs). An evidence map was created to summarize the absolute benefits of antibiotic prophylaxis in each scenario and certainty of evidence. RESULTS Seventy-five meta-analyses proved eligible with 725 RCTs and 78 clinical scenarios in surgical and medical prophylaxis. Of 119 health outcomes, 67 (56.3%) showed statistically significant benefits, 34 of which were supported by convincing or highly suggestive evidence from RCTs. For surgeries, antibiotic prophylaxis may minimize infection occurrences in most surgeries except Mohs surgery, simple hand surgery, herniorrhaphy surgery, hepatectomy, thyroid surgery, rhinoplasty, stented distal hypospadias repair, midurethral sling placement, endoscopic sinus surgery, and transurethral resection of bladder tumors with only low to very low certainty evidence. For nonsurgery invasive procedures, only low to very low certainty evidence showed benefits of antibiotic prophylaxis for cystoscopy, postoperative urinary catheterization, and urodynamic study. For medical prophylaxis, antibiotic prophylaxis showed greater benefits in nonemergency scenarios, in which patients were mainly with weakened immune systems, or at risk of recurrent chronic infections. Antibiotics prophylaxis may increase antibiotic resistance or other adverse events in most scenarios and reached significance in cystoscopy, afebrile neutropenia following chemotherapy and hematopoietic stem cell transplantation. CONCLUSIONS Antibiotic prophylaxis in surgical and nonsurgical scenarios is generally effective and seems independent of surgical cleanliness and urgency of diseases. Its safety is not well determined due to lack of available data. Nevertheless, the low quality of current evidence limits the external validity of these findings, necessitating clinicians to judiciously assess indications, balancing low infection rates with antibiotic-related side effects.
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Affiliation(s)
- Linhu Liu
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), and National Clinical Research Center for Geriatrics
| | - Zhongyu Jian
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), and National Clinical Research Center for Geriatrics
- West China Biomedical Big Data Centre, Sichuan University, Chengdu, People’s Republic of China
| | - Menghua Wang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), and National Clinical Research Center for Geriatrics
| | - Chi Yuan
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), and National Clinical Research Center for Geriatrics
| | - Ya Li
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), and National Clinical Research Center for Geriatrics
| | - Yucheng Ma
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), and National Clinical Research Center for Geriatrics
| | - Xi Jin
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), and National Clinical Research Center for Geriatrics
| | - Hong Li
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), and National Clinical Research Center for Geriatrics
| | - Yazhou He
- West China School of Public Health and West China Fourth Hospital
| | - Changhai Liu
- Division of Infectious Diseases, State Key Laboratory of Biotherapy and Centre of Infectious Disease, West China Hospital
| | - Sheyu Li
- Chinese Evidence-based Medicine Centre, Cochrane China Centre and MAGIC China Centre
- Department of Endocrinology and Metabolism
| | - Kunjie Wang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), and National Clinical Research Center for Geriatrics
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12
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Motan T, Cockwell H, Elliott J, Antaki R. Directive clinique n o446 : Chirurgie hystéroscopique dans les traitements de fertilité. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102399. [PMID: 38325735 DOI: 10.1016/j.jogc.2024.102399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
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13
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McLaren H, Hennessey C. First-trimester Procedural Abortion. Clin Obstet Gynecol 2023; 66:676-684. [PMID: 37750678 DOI: 10.1097/grf.0000000000000808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
First-trimester abortion is a common and safe procedure. A focused history and physical examination are essential for providing this care. Laboratory assessment can include Rh typing, hemoglobin, and cervicitis testing as indicated by a patient's risk factors. Procedural abortion in the first trimester includes cervical dilation with or without cervical preparation, and uterine evacuation utilizing a manual vacuum aspirator or electric vacuum aspirator. Complications occur rarely and are often easily managed at the time of diagnosis.
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Affiliation(s)
- Hillary McLaren
- Department of Obstetrics and Gynecology, Section of Complex Family Planning, University of Chicago, Chicago, Illinois
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Ekanem E, Ngene NC, Moodley J, Konje J. Prevention of surgical site infection and sepsis in pregnant obese women. Best Pract Res Clin Obstet Gynaecol 2023; 91:102406. [PMID: 37666023 DOI: 10.1016/j.bpobgyn.2023.102406] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/16/2023] [Accepted: 08/06/2023] [Indexed: 09/06/2023]
Abstract
Obesity is a major determinant of health outcomes and is on the increase in women worldwide. It predisposes to surgical site infection (SSI). Risk factors for the SSI include extremes of age, smoking, comorbidities such as hypertension and diabetes, inappropriate vertical abdominal and or uterine wall incisions, increased operating time, subcutaneous layer of 3 cm or more, and unnecessary use of subcutaneous drain. Most bacteria that cause SSIs are human commensals. Common organisms responsible for SSI include Staphylococcus aureus and coliforms such as Proteus mirabilis, and Escherichia coli. A surgeon's gloves post caesarean section in the obese has a preponderance of Firmicutes and Bacteroidetes, which increases SSI risk. The interaction of skin commensals and vaginal microbiome at the surgical incision site increases the risk of SSI in the obese compared to non-obese. Minimizing the risk of SSI involves modification of risk factors, timely treatment of SSI to prevent sepsis and compliance with the recommended care bundles.
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Affiliation(s)
- Emmanuel Ekanem
- Betsi Cadwaladr University Health Board, Ysbyty Gwynedd Hospital, Wales, UK.
| | - Nnabuike Chibuoke Ngene
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Obstetrics and Gynaecology, Leratong Hospital, Krugersdorp, South Africa
| | - Jagidesa Moodley
- Women's Health and HIV Research Group, Department of Obstetrics and Gynaecology, School of Clinical Medicine, Faculty of Health Sciences, University of Kwa Zulu-Natal, Durban, South Africa
| | - Justin Konje
- Feto Maternal Center, Al Markhiya, Doha, Qatar; Weill Cornell Medicine, Qatar; Department of Health Sciences, University of Leicester, Leicester, UK
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15
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Cohen N, Kedem HI, Abu-Foul L, Paz M, Kaufman Y, Lavie O, Zilberlicht A. Does vaginal cleansing with iodine decreases infection rate in office hysteroscopy? Arch Gynecol Obstet 2023; 308:1791-1796. [PMID: 37653251 DOI: 10.1007/s00404-023-07199-y] [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: 07/05/2023] [Accepted: 08/19/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE To determine whether preoperative vaginal cleansing with iodine-based solution prior to hysteroscopy, reduces postoperative infection rate compared to no vaginal cleansing. METHODS A retrospective study at a single tertiary, university affiliated hospital of all individuals who have had an office hysteroscopy. Study group consisted of patients who have had preoperative vaginal cleansing with iodine-based solution and were compared to those who have not. Any procedural related complaints at the 30 days following the hysteroscopy were recorded. RESULTS A total of 505 were available for analysis, 183 in the study group and 322 in the control group. The most common indications for operation were infertility evaluation (33.9% vs. 28.6%) and retained products of conception (33.3% vs. 29.2%), and most common procedures were diagnostic only (49.7% vs. 42.5%) followed by adhesiolysis (12% vs. 14.3%). No statistical differences were noted with regards to postoperative infections, as only one case of pelvic inflammatory disease was noted, in the iodine cleansing group (0.19% for postoperative infection). CONCLUSION Our comparative study may suggest that the use of preoperative iodine solution prior to office hysteroscopy does not decrease the postoperative infection rate up to 30 days, thus can be avoided.
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Affiliation(s)
- Nadav Cohen
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa, Israel.
- Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
| | - Hagit Itzhak Kedem
- Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Luna Abu-Foul
- Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Moran Paz
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa, Israel
- Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Yuval Kaufman
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa, Israel
- Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Ofer Lavie
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa, Israel
- Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Ariel Zilberlicht
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa, Israel
- Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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16
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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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17
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Lim SH, Park JJ, Kim CK. [Transvaginal Ultrasound-Guided Biopsy]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:1233-1243. [PMID: 38107698 PMCID: PMC10721409 DOI: 10.3348/jksr.2023.0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/29/2023] [Accepted: 09/16/2023] [Indexed: 12/19/2023]
Abstract
Percutaneous ultrasound-guided biopsy is useful for the pathologic confirmation of variable body lesions to establish diagnostic and therapeutic approaches. However, deep pelvic lesions are a challenge for pathologic diagnoses because of the presence of the bowel, bladder, major vessels, and pelvic bones which make a percutaneous approach difficult and dangerous. In female, the vagina is elastic and near the pelvic internal organs. Therefore, transvaginal ultrasound may serve as an effective and safe guide for the pathologic diagnosis of pelvis lesions. This review aimed to introduce the indications for, and the method of transvaginal ultrasound-guided biopsy, and to describe the reported diagnostic accuracy and safety.
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18
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Zhang W, French H, O'Brien M, Movilla P, Isaacson K, Morris S. Incidence of Intrauterine Adhesions After Hysteroscopic Myomectomy in Patients Seeking Fertility. J Minim Invasive Gynecol 2023; 30:805-812. [PMID: 37247808 DOI: 10.1016/j.jmig.2023.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/18/2023] [Accepted: 05/20/2023] [Indexed: 05/31/2023]
Abstract
STUDY OBJECTIVE To study the incidence of intrauterine adhesions (IUAs) after hysteroscopic myomectomy. Previous studies report a range of incidence for IUAs after hysteroscopic myomectomy. DESIGN A retrospective review study. SETTING An academic community hospital in the Boston metropolitan area. PATIENTS Patients undergoing hysteroscopic myomectomy at our institution from January 2019 to February 2022. Patients were excluded if they did not have plans for future fertility or had a new diagnosis of cancer. INTERVENTIONS All patients underwent hysteroscopic myomectomy using bipolar resectoscope without postoperative medical or barrier treatment. All procedures were performed by 1 of 4 fellowship-trained high-volume gynecologic surgeons with resident and fellow assistance. Incidence of postoperative IUAs was assessed and treated using second-look office hysteroscopy. MEASUREMENTS AND MAIN RESULTS A total of 44 patients without preoperative IUAs underwent hysteroscopic myomectomy during our study period, and 4 patients (9.1%) developed new IUAs. Among 9 patients who were found to have preoperative IUAs and underwent concurrent hysteroscopic myomectomy and lysis of adhesions, we found a recurrence of IUAs in 5 patients (55.6%). We found the number, size, and deepest type of myoma removed were not correlated to an increased risk of new IUA formation. In addition, removing myomas on opposing walls during the same operation did not increase the incidence of new IUAs. CONCLUSION Formation of IUAs after hysteroscopic myomectomy is a well-documented consequence. Our reported incidence of 9.1% of new IUAs that are not affected by the number, size, deepest type of myoma resected, and resection of myomas on opposing uterine walls contributes to the current literature. In addition, our finding of 55.6% of recurrent IUAs in patients undergoing both hysteroscopic myomectomy and lysis of adhesions highlights a high-risk population requiring additional study.
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Affiliation(s)
- Wenjia Zhang
- Minimally Invasive Gynecologic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts (all authors).
| | - Hannah French
- Minimally Invasive Gynecologic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts (all authors)
| | - Mollie O'Brien
- Minimally Invasive Gynecologic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts (all authors)
| | - Peter Movilla
- Minimally Invasive Gynecologic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts (all authors)
| | - Keith Isaacson
- Minimally Invasive Gynecologic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts (all authors)
| | - Stephanie Morris
- Minimally Invasive Gynecologic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts (all authors)
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19
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Balagna SJ, Boyd C, Arnold DE, Wagner CA, Veronikis DK, Short M, Butler J, Marquart S. Implementing a Bundle to Improve Surgical Site Infection Rates for Patients Undergoing Nonvaginal-Approach Hysterectomy at a Midwestern Teaching Hospital. AORN J 2023; 118:240-248. [PMID: 37750800 DOI: 10.1002/aorn.13999] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 09/27/2023]
Abstract
Accrediting organizations, third-party payers, and patients review the surgical site infection (SSI) rates of health care organizations. Infection preventionists collaborate with perioperative personnel to decrease SSI rates; they also monitor and report SSI information to national organizations. The standard infection ratio is a comparison of the observed number of SSIs to the predicted number of SSIs based on national benchmark data. Leaders of a midwestern teaching hospital convened an interdisciplinary team (eg, surgeons, perioperative leaders, infection preventionists) to address a standard infection ratio after hysterectomies that was greater than 1.0. The team reviewed national guidelines and published articles on decreasing SSIs (including recommendations for vaginal preparation) before developing and implementing a hysterectomy-specific bundle for SSI prevention. The rate of SSIs decreased 68% after the implementation of the bundle. Perioperative personnel at this facility continue to use the bundle and infection preventionists monitor and report compliance with the bundle's elements.
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20
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Lozo S, Wagner D, Shah N, Goldberg R, Gafni-Kane A, Solomonides A. Should Penicillin Allergy Testing Be Included as Part of Preoperative Testing? J Healthc Qual 2023; 45:255-260. [PMID: 37428901 DOI: 10.1097/jhq.0000000000000395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
INTRODUCTION Penicillin allergy is the most commonly reported drug allergy in the United States. Patients labeled with penicillin allergy are at risk of receiving broad-spectrum antibiotics for surgical site infection prophylaxis, which can lead to increased antibiotic resistance, higher morbidity, suboptimal antibiotic therapy, and higher medical costs. This study aimed to determine the true prevalence of penicillin allergy among surgical patients and to decrease the unnecessary use of broad-spectrum antibiotics. METHODS A retrospective chart review was performed of patients who underwent urogynecologic surgery in 2017. In 2018, a quality initiative was started, and all patients reporting penicillin allergies were offered antibiotic allergy testing as part of their preoperative testing. RESULTS In 2017, 15% of patients reported penicillin allergy and 52% of them received surgical prophylaxis with broad-spectrum antibiotics. In 2018, 463 patients underwent surgery, 55 of whom reported penicillin allergy and were offered penicillin allergy testing. 35 (64%) agreed to proceed with testing, and of those tested, 33 (94%) tested negative for penicillin allergy. CONCLUSIONS 94% of patients with stated penicillin allergy who consented to allergy testing proved to have negative test. Penicillin allergy testing should be considered as part of preoperative management.
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21
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Banwarth-Kuhn B, McQuade M, Krashin JW. Vaginal Bleeding Before 20 Weeks Gestation. Obstet Gynecol Clin North Am 2023; 50:473-492. [PMID: 37500211 DOI: 10.1016/j.ogc.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Conditions that often present with vaginal bleeding before 20 weeks are common and can cause morbidity and mortality. Clinically stable patients can choose their management options. Clinically unstable patients require urgent procedural management: uterine aspiration, dilation and evacuation, or surgical removal of an ectopic pregnancy. Septic abortion requires prompt procedural management, intravenous antibiotics, and intravenous fluids. Available data on prognosis with expectant management of pre-viable rupture of membranes in the United States are poor for mothers and fetuses.
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Affiliation(s)
| | | | - Jamie W Krashin
- Department of Obstetrics & Gynecology, University of New Mexico Health Sciences Center, MSC 10 5580, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA.
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22
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McCormack L, Song S, Budden A, Ma C, Nguyen K, Li FG, Lim CY, Maheux-Lacroix S, Arnold A, Deans R, Won HR, Knapman B, Nesbitt-Hawes E, Abbott JA. Immediate versus delayed urinary catheter removal following non-hysterectomy benign gynaecological laparoscopy: a randomised trial. BJOG 2023; 130:1112-1119. [PMID: 36852512 DOI: 10.1111/1471-0528.17442] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/06/2023] [Accepted: 01/17/2023] [Indexed: 03/01/2023]
Abstract
OBJECTIVE To compare rates of urinary retention and postoperative urinary tract infection between women with immediate versus women with delayed removal of indwelling catheter following benign non-hysterectomy gynaecological laparoscopic surgery. DESIGN This randomised clinical trial was conducted between February 2012 and December 2019, with follow-up to 6 weeks. SETTING Two university-affiliated teaching hospitals in Sydney, Australia. POPULATION Study participants were 693 women aged 18 years or over, undergoing non-hysterectomy laparoscopy for benign gynaecological conditions, excluding pelvic floor or concomitant bowel surgery. METHODS Three hundred and fifty-five participants were randomised to immediate removal of urinary catheter and 338 participants were randomised to delayed removal of urinary catheter. MAIN OUTCOME MEASURES The co-primary outcomes were urinary retention and urinary tract infection. Secondary outcomes included hospital readmission, analgesia requirements, duration of hospitalisation and validated bladder function questionnaires. RESULTS Urinary retention was higher after immediate compared with delayed removal of the urinary catheter (8.2% vs 4.2%, RR 1.8, 95% CI 1.0-3.0, p = 0.04). Although urinary tract infection was 7.2% following delayed removal of the urinary catheter and 4.7% following immediate removal of the urinary catheter, the difference was not statistically significant (RR 0.7, 95% CI 0.3-1.2, p = 0.2). CONCLUSIONS There is an increased risk of urinary retention with the immediate compared with the delayed removal of the urinary catheter following benign non-hysterectomy gynaecological laparoscopic surgery. The difference in urinary tract infection was not significant. There is 1/12 risk of re-catheterisation after immediate urinary catheter removal. It is important to ensure that patients report normal voiding and emptying prior to discharge, to reduce the need for readmission for the management of urinary retention.
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Affiliation(s)
- Lalla McCormack
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Sophia Song
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Aaron Budden
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Christine Ma
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Kimberly Nguyen
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Fiona G Li
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Claire Y Lim
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Sarah Maheux-Lacroix
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Amy Arnold
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Rebecca Deans
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Ha Ryun Won
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Blake Knapman
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Erin Nesbitt-Hawes
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Jason A Abbott
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
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23
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Marshall C, Estes SJ. Reproductive Surgery in Females with Obesity: Reproductive Consequences of Obesity and Applications for Surgical Care. Semin Reprod Med 2023; 41:97-107. [PMID: 37967852 DOI: 10.1055/s-0043-1776915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
Obesity is the most common medical problem in women of reproductive age. The surgical applications for this population, many of who are interested in current or future fertility, are critical to safe and effective evaluation and management of issues that impact the reproductive system. As rates of obesity continue to rise worldwide, it is projected that one in two individuals will have obesity by 2030 leading to increasing numbers of individuals affected by a disease process that has implications for their gynecologic surgical care, fertility-related assessment, and infertility treatment. Offering patients with obesity access to safe reproductive surgery is a cornerstone of reproductive autonomy. This review will summarize current recommendations regarding surgical concepts for the operating room, office hysteroscopy, oocyte retrieval, and embryo transfer in female patients with obesity.
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Affiliation(s)
- Ciara Marshall
- Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Stephanie J Estes
- Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
- Division of Reproductive Endocrinology and Infertility, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
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Lambert KA, Honart AW, Hughes BL, Kuller JA, Dotters-Katz SK. Antibiotic Recommendations After Postpartum Uterine Exploration or Instrumentation. Obstet Gynecol Surv 2023; 78:438-444. [PMID: 37480294 DOI: 10.1097/ogx.0000000000001167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
Importance Multiple postpartum scenarios require uterine exploration or instrumentation. These may introduce bacteria into the uterus, increasing the risk of endometritis. Data on the use of antibiotics in these scenarios is limited, resulting in few guidelines and divergent care. Objective To describe postpartum scenarios requiring uterine exploration and/or instrumentation, review data on antibiotic prophylaxis, and delineate antibiotic recommendations for each scenario. Evidence Acquisition Original articles were obtained from literature search in PubMed, MEDLINE, and OVID; pertinent articles were reviewed. Results These recommendations are based on published evidence and professional society guidelines. Antibiotic prophylaxis following manual placenta removal should include 1-time combination of ampicillin 2 g intravenously (IV) or cefazolin 1 g IV, plus metronidazole 500 mg IV. Antibiotic prophylaxis before postpartum dilation and curettage, manual vacuum aspiration, and intrauterine balloon tamponade should include 1-time combination of ampicillin 2 g IV plus metronidazole 500 mg IV. If the patient in any of the above scenarios has received group B Streptococcus prophylaxis, then only metronidazole is recommended. Further randomized clinical trials are needed to optimize these regimens. Conclusions Uterine exploration or instrumentation increases the risk of postpartum endometritis and requires antibiotic prophylaxis. For manual placenta removal, we recommend 1-time combination of ampicillin 2 g IV or cefazolin 1 g IV, plus metronidazole 500 mg IV. For dilation and curettage, manual vacuum aspiration, and intrauterine balloon tamponade, we recommend 1-time combination of ampicillin 2 g IV plus metronidazole 500 mg IV. For patients who already received antibiotic prophylaxis for group B Streptococcus, we recommend 1-time dose of metronidazole 500 mg IV. Relevance Providers can utilize our guidelines to prevent postpartum endometritis in these scenarios requiring postpartum uterine exploration and/or instrumentation.
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Affiliation(s)
| | | | | | - Jeffrey A Kuller
- Professor, Department of Obstetrics and Gynecology, Duke University, Durham, NC
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Okamura A, Isono W, Tsuchiya A, Honda M, Saito A, Tsuchiya H, Matsuyama R, Fujimoto A, Nishii O. Preventive effect of metronidazole vaginal tablets on vaginal bacteria-related postoperative complications with total laparoscopic hysterectomy. J Med Case Rep 2023; 17:47. [PMID: 36782233 PMCID: PMC9926539 DOI: 10.1186/s13256-023-03789-1] [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: 03/03/2022] [Accepted: 01/23/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND The use of total laparoscopic hysterectomy is increasing. However, as with conventional abdominal hysterectomy, vaginal bacteria-related postoperative complications need to be managed in total laparoscopic hysterectomy. Therefore, we started to combine metronidazole vaginal tablets with intravenous administration of cephem antibiotics immediately before starting surgery to reduce complications. To evaluate the effect of this combination, and to determine the risk factors for these complications, we retrospectively collected medical records from our hospital and performed a multivariate analysis. METHODS We reviewed the medical records of 520 patients who underwent total laparoscopic hysterectomy from 1 January 2015 to 31 December 2021. Among these cases, we identified 16 cases as having vaginal bacteria-related postoperative complications, defined as needing more than one additional day for treatment of postoperative complications, namely postoperative infection (10 cases) and vaginal dehiscence (6 cases). First, we evaluate the effect of metronidazole vaginal tablets by dividing the patients into two groups according to whether metronidazole vaginal tablets were used, and comparing the vaginal bacteria-related postoperative complication rates and other indices. Second, we performed a multivariate logistic regression analysis to assess the influence of each of 17 representative factors, including patient characteristics and symptoms, uterus and leiomyoma sizes, concomitant procedures such as laparoscopic cystectomy and pelvic lymphadenectomy, and others. RESULTS In the multivariate analysis of the 520 cases, we confirmed that the use of metronidazole vaginal tablets could reduce the vaginal bacteria-related postoperative complications rate by more than half (odds ratio, 0.36). In addition to metronidazole vaginal tablets use, concomitant laparoscopic cystectomy and blood transfusion were associated with significant increases in the vaginal bacteria-related postoperative complication rate. CONCLUSIONS The effect of the addition of metronidazole vaginal tablets to pre- and postsurgical treatment on the reduction of vaginal bacteria-related postoperative complications was confirmed. This easy, safe, and low-cost method may improve the management of total laparoscopic hysterectomy.
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Affiliation(s)
- Asuka Okamura
- Department of Obstetrics and Gynaecology, University Hospital Mizonokuchi, Teikyo University School of Medicine, 5-1-1, Futago, Takatsu-Ku, Kawasaki, Kanagawa 213-8507 Japan
| | - Wataru Isono
- Department of Obstetrics and Gynaecology, University Hospital Mizonokuchi, Teikyo University School of Medicine, 5-1-1, Futago, Takatsu-Ku, Kawasaki, Kanagawa 213-8507 Japan
| | - Akira Tsuchiya
- Department of Obstetrics and Gynaecology, University Hospital Mizonokuchi, Teikyo University School of Medicine, 5-1-1, Futago, Takatsu-Ku, Kawasaki, Kanagawa 213-8507 Japan
| | - Michiko Honda
- Department of Obstetrics and Gynaecology, University Hospital Mizonokuchi, Teikyo University School of Medicine, 5-1-1, Futago, Takatsu-Ku, Kawasaki, Kanagawa 213-8507 Japan
| | - Ako Saito
- Department of Obstetrics and Gynaecology, University Hospital Mizonokuchi, Teikyo University School of Medicine, 5-1-1, Futago, Takatsu-Ku, Kawasaki, Kanagawa 213-8507 Japan
| | - Hiroko Tsuchiya
- Department of Obstetrics and Gynaecology, University Hospital Mizonokuchi, Teikyo University School of Medicine, 5-1-1, Futago, Takatsu-Ku, Kawasaki, Kanagawa 213-8507 Japan
| | - Reiko Matsuyama
- Department of Obstetrics and Gynaecology, University Hospital Mizonokuchi, Teikyo University School of Medicine, 5-1-1, Futago, Takatsu-Ku, Kawasaki, Kanagawa 213-8507 Japan
| | - Akihisa Fujimoto
- Department of Obstetrics and Gynaecology, University Hospital Mizonokuchi, Teikyo University School of Medicine, 5-1-1, Futago, Takatsu-Ku, Kawasaki, Kanagawa 213-8507 Japan
| | - Osamu Nishii
- Department of Obstetrics and Gynaecology, University Hospital Mizonokuchi, Teikyo University School of Medicine, 5-1-1, Futago, Takatsu-Ku, Kawasaki, Kanagawa 213-8507 Japan
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Kishkovich TP, Sinnott CM, Dimitriadis I. Case series of tubo-ovarian abscesses after saline infusion sonohysterography: reconsidering antibiotic prophylaxis. Minerva Obstet Gynecol 2023; 75:80-84. [PMID: 36790400 DOI: 10.23736/s2724-606x.22.05070-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Saline infusion sonohysterography (SIS) is useful for evaluating intrauterine pathology, particularly for patients with abnormal uterine bleeding and during assessment of infertility. Infectious complications are relatively rare, and tubo-ovarian abscess (TOA) after SIS has only been reported once in the literature. We present two additional cases of TOA after SIS that presented to our institution. First, a 40-year-old female with known endometriosis and bilateral tubal occlusion, presented with ruptured TOA fifteen days after SIS during fertility evaluation. The second, a 45-year-old female with endometriomas and a hydrosalpinx identified on SIS, diagnosed with TOAs four days after SIS for abnormal uterine bleeding evaluation. While hysterosalpingogram has defined antibiotic prophylaxis criteria, and despite likely similar mechanisms for ascending infections, current guidelines do not recommend prophylaxis after SIS. These cases suggest infectious complications, such as TOA, after SIS may be more common than previously reported, and as demonstrated by these cases can have serious clinical consequences for patients. Furthermore, by comparing to a technically similar procedure as HSG, it may be reasonable to consider if certain patients at high risk of complication may benefit from antibiotic prophylaxis to prevent serious clinical infections.
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Affiliation(s)
- Thomas P Kishkovich
- Harvard Medical School, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard University, Boston, MA, USA -
| | - Colleen M Sinnott
- Harvard Medical School, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Irene Dimitriadis
- Harvard Medical School, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard University, Boston, MA, USA
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Zmora O, Stark Y, Belotserkovsky O, Reichert M, Kozloski GA, Wasserberg N, Tulchinsky H, Segev L, Senagore AJ, Emanuel N. A prospective, randomized assessment of a novel, local antibiotic releasing platform for the prevention of superficial and deep surgical site infections. Tech Coloproctol 2023; 27:209-215. [PMID: 36050560 PMCID: PMC9898410 DOI: 10.1007/s10151-022-02693-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/16/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Despite significant advances in infection control guidelines and practices, surgical site infections (SSIs) remain a substantial cause of morbidity, prolonged hospitalization, and mortality among patients having both elective and emergent surgeries. D-PLEX100 is a novel, antibiotic-eluting polymer-lipid matrix that supplies a high, local concentration of doxycycline for the prevention of superficial and deep SSIs. The aim of our study was to evaluate the safety and efficacy of D-PLEX in addition to standard of care (SOC) in preventing superficial and deep surgical site infections for patients undergoing elective colorectal surgery. METHODS From October 10, 2018 to October 6, 2019, as part of a Phase 2 clinical trial, we randomly assigned 202 patients who had scheduled elective colorectal surgery to receive either standard of care SSI prophylaxis or D-PLEX100 in addition to standard of care. The primary objective was to assess the efficacy of D-PLEX100 in superficial and deep SSI reduction, as measured by the incidence of SSIs within 30 days, as adjudicated by both an individual assessor and a three-person endpoint adjudication committee, all of whom were blinded to study-group assignments. Safety was assessed by the stratification and incidence of treatment-emergent adverse events. RESULTS One hundred and seventy-nine patients were evaluated in the per protocol population, 88 in the intervention arm [51 males, 37 females, median age (64.0 range: 19-92) years] and 91 in the control arm [57 males, 34 females, median age 64.5 (range: 21-88) years]. The SSI rate within 30 day post-index surgery revealed a 64% relative risk reduction in SSI rate in the D-PLEX100 plus standard of care (SOC) group [n = 7/88 (8%)] vs SOC alone [n = 20/91 (22%)]; p = 0.0115. There was no significant difference in treatment-emergent adverse events. CONCLUSIONS D-PLEX100 application leads to a statistically significant reduction in superficial and deep surgical site infections in this colorectal clinical model without any associated increase in adverse events.
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Affiliation(s)
- O Zmora
- Shamir Medical Center, Be'er Ya'akov, Israel
| | - Y Stark
- PolyPid Ltd, Petach Tikvah, Israel
| | | | | | | | - N Wasserberg
- Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel
| | - H Tulchinsky
- Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - L Segev
- Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
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28
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Albakr RB, Bargman JM. Care of the hospitalised patient receiving peritoneal dialysis: Your questions answered. ARCH ESP UROL 2023; 43:5-12. [PMID: 36113128 DOI: 10.1177/08968608221125714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Peritoneal dialysis (PD) patients have higher hospitalisation rates than the general population. The hospitalisations are not always related to dialysis issues, and physicians with little or no experience with PD may be responsible for the care of these hospitalised patients. Furthermore, the hospital may not be familiar with or equipped to manage these patients. This review highlights barriers, knowledge gaps and management strategies to guide the care of hospitalised PD patients.
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Affiliation(s)
- Rehab B Albakr
- Division of Nephrology, University of Toronto, Toronto, ON, Canada.,Division of Nephrology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Joanne M Bargman
- Division of Nephrology, University of Toronto, University Health Network/Toronto General Hospital, Toronto, ON, Canada
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Salmanov AG, Kostikov VV, Lytvak O, Voloshyn OA, Lysenko B, Struk T, Gordiichuk O. POSTOPERATIVE INFECTIONS AFTER GYNECOLOGICAL SURGERIES IN UKRAINE. POLSKI MERKURIUSZ LEKARSKI : ORGAN POLSKIEGO TOWARZYSTWA LEKARSKIEGO 2023; 51:299-305. [PMID: 37756447 DOI: 10.36740/merkur202304101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
OBJECTIVE Aim: To determine the current prevalence of surgical site infections (SSIs) after gynecological surgeries and antimicrobial resistance of causing pathogens in Ukraine. PATIENTS AND METHODS Materials and Methods: Multicenter prospective observational cohort study was conducted from January 2020 to December 2022 in nine hospitals from eight regions of Ukraine. Definitions of HAIs were adapted from the Centers for Disease Control and Prevention's National Healthcare Safety Network. Antibiotic susceptibility was done by the disc diffusion test as recommended by EUCAST. RESULTS Results: A total 12.2% (420/3450) patients who undergoing gynecological surgeries were found to have SSIs. The difference in SSI rates between the three subgroups by route of surgery was not statistically significant, being 12.0% for the abdominal group,11.1% for the vaginal group, and 12.5% for the combined group. The most common causing pathogens of SSIs was Escherichia coli, Pseudomonas aeruginosa, Enterobacter spp., Streptococcus spp., and Klebsiella pneumoniae. Many Gram-negative pathogens isolated from SSI cases were found to be multidrug resistant. CONCLUSION Conclusions: This study showed that SSIs remains the common complication after gynecological procedures in Ukraine. Best practices should be established and followed to reduce the risk of SSIs associated with gynecologic surgery. Optimizing the antibiotic prophylaxis and empirical antimicrobial therapy may reduce the burden of SSIs in gynecological surgeries, but prevention is the key element.
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Affiliation(s)
- Aidyn G Salmanov
- SHUPYK NATIONAL HEALTHCARE UNIVERSITY OF UKRAINE, KYIV, UKRAINE; INSTITUTE OF PEDIATRICS, OBSTETRICS AND GYNECOLOGY OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE, KYIV, UKRAINE
| | | | - Olena Lytvak
- STATE SCIENTIFIC INSTITUTION "SCIENTIFIC AND PRACTICAL CENTER OF PREVENTIVE AND CLINICAL MEDICINE" OF THE AGENCY OF STATE AFFAIRS, KYIV, UKRAINE
| | - Oleksandr A Voloshyn
- SHUPYK NATIONAL HEALTHCARE UNIVERSITY OF UKRAINE, KYIV, UKRAINE; KYIV REGIONAL MATERNITY HOSPITAL, KYIV, UKRAINE
| | - Boleslav Lysenko
- STATE SCIENTIFIC INSTITUTION "SCIENTIFIC AND PRACTICAL CENTER OF PREVENTIVE AND CLINICAL MEDICINE" OF THE AGENCY OF STATE AFFAIRS, KYIV, UKRAINE
| | - Tetiana Struk
- KHARKIV NATIONAL MEDICAL UNIVERSITY, KHARKIV, UKRAINE
| | - Olga Gordiichuk
- NATIONAL PIROGOV MEMORIAL MEDICAL UNIVERSITY, VINNYTSIA, UKRAINE
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Intraoperative Gentamicin Intravesical Instillation for Prevention of Urinary Tract Infection After Urogynecologic Surgery: A Randomized Controlled Trial. UROGYNECOLOGY (HAGERSTOWN, MD.) 2022; 28:825-833. [PMID: 36409639 DOI: 10.1097/spv.0000000000001233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
IMPORTANCE Currently available evidence for efficacy of postoperative antibiotics to prevent postoperative urinary tract infection (UTI) conflicts. Oral antibiotics rely on patient adherence and can cause unwanted systemic effects. Gentamicin is a broad-spectrum antibiotic with rapid bactericidal activity and, when administered intravesically, has no systemic absorption through intact urothelium. OBJECTIVE We aimed to determine whether a single intravesical instillation of gentamicin at the conclusion of urogynecologic surgery would reduce the proportion of women treated for UTI within 6 weeks postoperatively compared with sham instillation. STUDY DESIGN This was a multicenter, randomized (stratified by study site, route of prolapse repair ±suburethral sling, with balanced 1:1 randomization), participant-masked, sham-controlled, study. The primary outcome was the proportion of participants treated with antibiotics for UTI within 6 weeks postoperatively. An adjusted multivariable logistic regression model was constructed to determine predictors of postoperative UTI treatment. RESULTS Three hundred seventy participants were randomized (gentamicin, 185; sham, 185), and data from 363 participants were analyzed (gentamicin, 183; sham, 180). Nineteen women in the gentamicin group and 20 women in the sham group were treated for UTI within 6 weeks postoperatively (10.4% vs 11.1%, P = 0.87). There were no adverse events related to the instillations. Increasing age (odds ratio, 1.028 [1.000-1.057]) and number of intraoperative transurethral instrumentations (odds ratio, 1.342 [1.080-1.668]) were independent predictors of postoperative UTI treatment. CONCLUSIONS In women undergoing urogynecologic surgery, postoperative intravesical gentamicin did not reduce the incidence of postoperative UTI. The number of intraoperative transurethral instrumentations is an important, potentially modifiable risk factor for postoperative UTI treatment.
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Jin J, Fan X, Dong X, Zhai X, Ma Y, Tang J. Infection and the evaluation of biomarkers in obstetrics and gynecology patients with infectious disease: a retrospective observational study from clinical pharmacists’ consultation experience. Eur J Med Res 2022; 27:229. [PMID: 36329535 PMCID: PMC9635140 DOI: 10.1186/s40001-022-00850-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/08/2022] [Indexed: 11/05/2022] Open
Abstract
Background The use of empirical anti-infective medication calls for the identification of common pathogens and accurate infectious biomarkers. However, clinical pharmacists’ anti-infective experience in the field of obstetrics and gynaecology is rare in the literature. This study aimed to retrospectively analyze the correlation between the anti-infective effectiveness after 7 days of antibiotic treatment and infectious biomarkers, according to clinical pharmacists’ consultation cases of gynecological and obstetric infections. Methods In this retrospective study, clinical pharmacists’ anti-infective consultation experiences applied by physicians from January 1, 2018, to December 31, 2020, were included. The exclusion criteria were as follows: (1) the patient died or left the hospital before undergoing an effectiveness evaluation after the consultation; (2) treatment was discontinued due to adverse reactions related to antibiotics; (3) the patient did not undergo an effectiveness evaluation within 3 or 7 days after application of the clinical pharmacist’s treatment plan; and (4) the physician did not adopt the clinical pharmacist’s suggestions. The registered information included patient characteristics, pathological bacteria, anti-infective medication and changes in infection indices before and after treatment. Statistical analysis of temperature, white blood cells (WBCs), C-reactive protein (CRP), procalcitonin (PCT) and WBCs in urine after 3 days and 7 days of anti-infective treatment, compared with before anti-infective treatment, was performed by the chi-square test. A t test was conducted to further study WBC count and CRP. A receiver operating characteristic curve verified the sensitivity and specificity of WBC count, CRP and PCT. Results A total of 265 cases were included. The CRP levels of patients 3 d and 7 d after antibiotic treatment were significantly lower than before antibiotic treatment (P < 0.05, P < 0.01), while the WBC count showed a downward trend after 3 days and a significant decrease after 7 days (P < 0.01). The areas under the curve (AUCs) for prognosis on the 7th day for WBC count, CRP and PCT were 0.90, 0.75 and 0.522, respectively. The AUC for WBC count combined with CRP was 0.90, which was higher than that for the biomarkers tested separately, especially compared to PCT. The most common gynecological infections were surgical site infection (SSI), urinary tract infection and fever of unknown origin, and the most common pathogens were E. coli and E. faecalis in Gram-negative and Gram-positive samples, respectively. Pharmacists’ recommended treatment plans included carbapenems and β-lactam antibiotics. Conclusions Our dual-center study indicates that the combination of WBC count and CRP can improve diagnostic accuracy and treatment efficiency, and PCT alone is insensitive to gynecological infections, according to clinical pharmacists’ experience.
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Boraas CM, Carroll A, Hesse SP, Norkett E, Ralph JA. Management of Surgical Abortion Complications. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2022.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Christy M. Boraas
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Anna Carroll
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Steven P. Hesse
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Emily Norkett
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Jessika A. Ralph
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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33
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Approaches to Tumors of the Nail Unit and Genitalia. Dermatol Clin 2022; 41:163-174. [DOI: 10.1016/j.det.2022.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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34
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AUGS-IUGA Joint clinical consensus statement on enhanced recovery after urogynecologic surgery. Int Urogynecol J 2022; 33:2921-2940. [DOI: 10.1007/s00192-022-05223-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/19/2022] [Indexed: 10/14/2022]
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Schmidt PC, Fenner DE. Repair of episiotomy and obstetrical perineal lacerations (first-fourth). Am J Obstet Gynecol 2022:S0002-9378(22)00541-5. [PMID: 37427859 DOI: 10.1016/j.ajog.2022.07.005] [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: 05/13/2022] [Revised: 07/07/2022] [Accepted: 07/07/2022] [Indexed: 07/11/2023]
Abstract
Perineal injury after vaginal delivery is common, affecting up to 90% of women. Perineal trauma is associated with both short- and long-term morbidity, including persistent pain, dyspareunia, pelvic floor disorders, and depression, and may negatively affect a new mother's ability to care for her newborn. The morbidity experienced after perineal injury is dependent on the type of laceration incurred, the technique and materials used for repair, and the skill and knowledge of the birth attendant. After all vaginal deliveries, a systematic evaluation including visual inspection and vaginal, perineal, and rectal exams is recommended to accurately diagnose perineal lacerations. Optimal management of perineal trauma after vaginal birth includes accurate diagnosis, appropriate technique and materials used for repair, providers experienced in perineal laceration repair, and close follow-up. In this article, we review the prevalence, classification, diagnosis, and evidence supporting different closure methods for first- through fourth-degree perineal lacerations and episiotomies. Recommended surgical techniques and materials for different perineal laceration repairs are provided. Finally, best practices for perioperative and postoperative care after advanced perineal trauma are reviewed.
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Affiliation(s)
- Payton C Schmidt
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI.
| | - Dee E Fenner
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
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Lukies M, Clements W. Current Strategies for Prevention of Infection After Uterine Artery Embolisation. Cardiovasc Intervent Radiol 2022; 45:911-917. [PMID: 35578034 PMCID: PMC9225967 DOI: 10.1007/s00270-022-03158-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/12/2022] [Indexed: 11/28/2022]
Abstract
Uterine artery embolisation (UAE) is a safe and effective procedure for symptomatic uterine fibroids with an estimated rate of post-operative intra-uterine infection of 0.9-2.5%. While rates of infection have remained low over the past two decades, there is variation in infection prevention practices. Intra-uterine infection after UAE may occur via access site haematogenous spread or ascension of vaginal flora through the cervical canal. Although the evidence base is immature, risk factors for infection including previous pelvic infection, hydrosalpinx, endocervical incompetence, diabetes, smoking, obesity, respiratory disease, and immunosuppression should be assessed during the pre-operative consultation with the interventional radiologist to tailor a plan for minimising infection, which may include optimisation of any modifiable risk facts and prophylactic antibiotics.
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Affiliation(s)
- Matthew Lukies
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004 Australia
| | - Warren Clements
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004 Australia
- Department of Surgery, Monash University, Melbourne, VIC Australia
- National Trauma Research Institute, Melbourne, VIC Australia
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O'Hanlan KA, Bassett P. Exploring Adverse Events and Utilization of Topical Hemostatic Agents in Surgery. JSLS 2022; 26:JSLS.2022.00033. [PMID: 36071989 PMCID: PMC9439288 DOI: 10.4293/jsls.2022.00033] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background and Objectives: This retrospective study provides preliminary qualitative assessment of the adverse events (AEs), focusing on pelvic and abdominal AEs and patient outcomes reported for three hemostatic agents used in gynecologic surgery. Methods: Utilization rates for oxidized regenerated cellulose powder (ORC), polysaccharide powder (PSP), and fibrin sealant solution (FSS) were obtained from hospitals via the Premier Healthcare databases for all surgical procedures from January 1, 2018 to September 30, 2020. All reported cases were extracted from the Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database for ORC and PSP and from the FDA Adverse Event Reporting System (FAERS) database for FSS. Distributions of AEs by anatomical site (MAUDE/FAERS) and surgical procedures by specialty (Premier) were evaluated for each product. Number of cases and number and types of AEs were compared to the total utilization for each product. Results: PSP was the most used product during the period analyzed (n = 126,509 uses), followed by FSS (n = 80,628 uses), and ORC (n = 41,583 uses). Distribution of surgical procedures by anatomical site varied significantly between hemostatic agents (p < 0.001). ORC was associated with more patient cases with AEs and numbers of reported AEs compared with PSP and FSS (p < 0.001). ORC was associated with higher number of infections than PSP (p < 0.001) and FSS (p < 0.001). Conclusion: These findings suggest that ORC use in abdominal and pelvic surgery may result in more postoperative complications compared with non-ORC hemostatic agents. Further prospective randomized studies are needed to compare efficacy and safety of these products.
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A Randomized Clinical Trial Comparing the Efficacy and Safety of 2% Versus 4% Chlorohexidine Gluconate for Surgical Preparation of the Vagina. Female Pelvic Med Reconstr Surg 2022; 28:400-407. [PMID: 35543543 DOI: 10.1097/spv.0000000000001194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
IMPORTANCE There have been no studies comparing 2% and 4% chlorhexidine gluconate (CHX) for vaginal surgical site preparation despite both commonly being used. OBJECTIVES The primary objective was to assess the noninferiority of 2% CHX versus 4% CHX to reduce bacterial contamination rates at 60 minutes after surgical preparation of the vagina. Secondary objectives were to assess differences in colony-forming units and the sensation of postoperative vaginal burning and pain. STUDY DESIGN This is a single-blinded randomized controlled trial of women who underwent vaginal prolapse surgery. Study participants were randomized into 2 groups: 2% CHX versus 4% CHX. Two vaginal bacterial cultures were collected: (1) preoperatively before vaginal preparation and (2) intraoperatively at 60 minutes. A questionnaire on vaginal pain and burning was administered preoperatively and postoperatively. For our sample size, assuming that 2% CHX would have double the contamination rate of 4% CHX, 26 participants were needed per group to demonstrate noninferiority. RESULTS Sixty-one women participated in the study. There were no differences in baseline demographics, length of surgery, or surgical procedures. For our primary outcome, the postpreparation contamination rates were 7% for 2% CHX versus 10% for 4% CHX, with a difference of 3% ( P = 0.52). This difference did meet the criteria for noninferiority. Secondary outcomes were not different between groups. CONCLUSIONS Two percent CHX is noninferior to 4% CHX in reducing vaginal bacterial contamination at 60 minutes after vaginal surgical site preparation, with low rates of postpreparation contamination and vaginal discomfort.
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Stachowicz AM, Lambert JW, Hohmann SF, Whiteside JL. Physician and Hospital-level Variation in Hemostatic Agent Use in Benign Gynecologic Procedures. J Minim Invasive Gynecol 2022; 29:1149-1156. [PMID: 35781055 DOI: 10.1016/j.jmig.2022.06.022] [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: 03/09/2022] [Revised: 06/17/2022] [Accepted: 06/25/2022] [Indexed: 10/17/2022]
Abstract
STUDY OBJECTIVE To identify recent nationwide trends in hemostatic agent (HA) use and to explore factors associated with HA use in 3 benign gynecologic surgery contexts: isolated hysterectomy, pelvic organ prolapse repair, and anti-incontinence surgery. DESIGN Retrospective cohort study. SETTING Vizient Clinical Database. PATIENTS Three cohorts of female patients of ≥18 years who underwent benign isolated hysterectomy, pelvic organ prolapse repair, or anti-incontinence procedures were identified between October 2015 and December 2019. INTERVENTIONS HAs are topically applied procoagulant products used for surgical hemostasis and use during included encounters was determined by charge codes. MEASUREMENTS AND MAIN RESULTS Subject-, hospital-, and surgeon-level characteristics and costs were captured. Data were initially analyzed in the aggregate and based on procedure category using the chi-square test or independent samples t tests as appropriate. A bootstrap forest model was used to identify the factors most predictive of HA use. In the final cohort of 184 070 encounters, HAs were used most frequently in hysterectomy (20.7%) and least in anti-incontinence surgery (10.9%). The use of HAs increased from 15.6% in quarter 4 2015 to 19.2% in quarter 4 2019 (p <.001). Encounters using HAs cost more than encounters without HAs ($6271.10 vs $4572.00; p <.001). A bootstrap forest model inclusive of all variables found surgeon and hospital identity cumulatively predictive of 84.9% of HA use, 65.5% and 19.4%, respectively. There was significant variation in HA use among individual surgeons, with 59.9% never using HAs. Of those who did use HAs, 72.8% used HAs more frequently than the mean provider HA use rate (19.4%) and 9.2% used HAs in every case he/she performed. CONCLUSION The significant variation in HA use is driven primarily by physician and hospital identity, suggesting that use of HA in these benign gynecologic surgical contexts may be determined more by physician- and hospital-level factors than patient-level factors.
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Affiliation(s)
- Anne M Stachowicz
- Female Pelvic Medicine and Reconstructive Surgery, The Christ Hospital, (Dr. Stachowicz), Cincinnati, OH.
| | - Joshua W Lambert
- College of Nursing, University of Cincinnati (Dr. Lambert), Cincinnati, OH
| | - Samuel F Hohmann
- Center for Advanced Analytics and Informatics, Vizient Inc. (Dr. Hohmann), Chicago, IL; Department of Health Systems Management, Rush University (Dr. Hohmann), Chicago, IL
| | - James L Whiteside
- Department of Obstetrics and Gynecology, Brody School of Medicine, East Carolina University, Greenville, NC (Dr. Whiteside)
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Hendrickson WK, Havrilesky L, Siddiqui NY. Cost-effectiveness of bacteriuria screening before urogynecologic surgery. Am J Obstet Gynecol 2022; 226:831.e1-831.e12. [PMID: 34922920 DOI: 10.1016/j.ajog.2021.11.1375] [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: 09/04/2021] [Revised: 11/17/2021] [Accepted: 11/25/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Currently, there is controversy over who requires preoperative screening for bacteriuria in the urogynecologic population and whether treating asymptomatic bacteriuria reduces postoperative urinary tract infection rates. OBJECTIVE To evaluate the cost-effectiveness of selective, universal, and no preoperative bacteriuria screening protocols in women undergoing surgery for prolapse or stress urinary incontinence. STUDY DESIGN A simple decision tree model was created from a societal perspective to evaluate cost and effectiveness of 3 strategies to prevent postoperative urinary tract infection: (1) a universal protocol where all women undergoing urogynecologic surgery are screened for bacteriuria and receive preemptive treatment if bacteriuria is identified; (2) a selective protocol, where only women with a history of recurrent urinary tract infection are screened and treated for bacteriuria; and (3) a no-screening protocol, where no women are screened for bacteriuria. Our primary outcome was the incremental cost-effectiveness ratio, calculated in cost per quality-adjusted life-years. Secondary outcomes were the number of urine cultures, postoperative urinary tract infections, and pyelonephritis associated with each strategy. Costs were derived from the Centers for Medicare & Medicaid Services, Healthcare Cost and Utilization Project, and Medical Expenditure Panel Survey. Clinical estimates were derived from published literature and data from a historic surgical cohort. Quality-of-life-associated utilities for urinary tract infection (0.73), pyelonephritis (0.66), and antibiotic use (0.964) were derived from the published literature using the HALex scale, reported directly by affected patients. One-way sensitivity analyses were performed over the range of reported values. RESULTS In the base case scenario, selective screening is more costly (no screen: $101.69, selective: $101.98) and more effective (no screen: 0.096459 quality-adjusted-life-year, selective: 0.096464 quality-adjusted-life-year) than no screening, and is cost-effective, with an incremental cost-effectiveness ratio of $49,349 per quality-adjusted-life-year. Both selective screening and no screening dominate universal screening in being less costly (universal: $111.92) and more effective (universal: 0.096446 quality-adjusted-life-year), with a slightly higher rate of postoperative urinary tract infection (no screen: 17.1%, selective: 16.9%, universal: 16.6%). In 1-way sensitivity analyses, selective screening is no longer cost-effective compared with no screening when the cost of a urine culture exceeds $12, cost of a preoperative urinary tract infection exceeds $93, the cost of a postoperative urinary tract infection is below $339, the specificity of a urine culture is less than 96%, or preoperative bacteriuria rates in those without symptoms but a history of recurrent urinary tract infection is <23%. Universal screening only becomes cost-effective when the postoperative urinary tract infection rate increases to >50% in those without risk factors and untreated preoperative bacteriuria. When compared with no screening, selective screening costs an additional $104 per urinary tract infection avoided and $2607 per pyelonephritis avoided. Compared with selective screening, universal screening costs $4609 per urinary tract infection avoided and $115,223 per pyelonephritis avoided. CONCLUSION Implementation of a selective preoperative bacteriuria protocol is cost-effective in most scenarios and associated with only a <1% increase in the 30-day postoperative urinary tract infection rate. No screening is cost-effective when cost of a preoperative urinary tract infection is high and the rate of preoperative bacteriuria in those without risk factors is low.
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Meshaal H, Salah E, Fawzy E, Abdel-Rasheed M, Maged A, Saad H. Hysteroscopic management versus ultrasound-guided evacuation for women with first-trimester pregnancy loss, a randomised controlled trial. BMC Womens Health 2022; 22:190. [PMID: 35614405 PMCID: PMC9131545 DOI: 10.1186/s12905-022-01774-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/12/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE We aimed to evaluate the hysteroscopic management of first-trimester pregnancy loss compared to surgical evacuation either blind or under ultrasonographic guidance. METHODS This clinical trial included 315 women with first-trimester pregnancy loss, divided equally into three groups. Group 1 underwent traditional blind surgical evacuation, group 2 underwent ultrasound-guided evacuation, and group 3 underwent hysteroscopic management. All women were assessed for retained products, surgical complications, the need for further management, and pregnancy occurrence after evacuation within 2 years of follow up. RESULTS The rate of presence of conception remnants and the need for further treatment was significantly higher in group 1 compared to groups 2 and 3 (4.8% vs. 0% vs. 0%, P = 0.012). The conception rate within 2 years was significantly lower in group 1 compared to groups 2 and 3 (57.4% vs. 73.2% vs. 82.7%, P = 0.002), and the duration needed to conceive was significantly prolonged in group 1 compared to groups 2 and 3 (9.8 vs. 8.3 vs. 6.9 months, P < 0.001). Interestingly, women who underwent hysteroscopic management needed a significantly shorter time to conceive than those who underwent ultrasound-guided evacuation (6.9 vs. 8.3 months, P = 0.006). CONCLUSIONS Hysteroscopic management of first-trimester pregnancy loss was superior to ultrasound-guided surgical evacuation regarding the time interval to conceive. Both techniques were superior to the blind evacuation technique regarding removal of the whole conception remnants, need for further treatment and fertility outcomes. Clinical trial registration: It was first registered at ClinicalTrials.gov on 16/03/2017 with registration number NCT03081104.
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Affiliation(s)
- Hadeer Meshaal
- Obstetrics and Gynecology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Emad Salah
- Obstetrics and Gynecology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Eman Fawzy
- Obstetrics and Gynecology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mazen Abdel-Rasheed
- Reproductive Health Research Department, National Research Centre, 33 El-Buhouth St, Dokki, Cairo, 12622, Egypt.
| | - Ahmed Maged
- Obstetrics and Gynecology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hany Saad
- Obstetrics and Gynecology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Miceli LM, Chang OH, Zhang S, Yao M, Propst K. Antimicrobial Stewardship in Patients with Penicillin Allergy Undergoing Hysterectomy for Benign Indications. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2021.0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Lia M. Miceli
- Department of Obstetrics and Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Olivia H. Chang
- Department of Obstetrics and Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Center for Urogynecology and Pelvic Reconstructive Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Salina Zhang
- Case Western Reserve School of Medicine, Cleveland, Ohio, USA
| | - Meng Yao
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Katie Propst
- Department of Obstetrics and Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Center for Urogynecology and Pelvic Reconstructive Surgery, Cleveland Clinic, Cleveland, Ohio, USA
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DeMari JA, Boyles GP, Barrington DA, Audrey Busho BS, Jae Baek BS, Cohn DE, Nagel CI. Less is more: Abdominal closure protocol does not reduce surgical site infection after hysterectomy. Gynecol Oncol 2022; 166:69-75. [PMID: 35525601 DOI: 10.1016/j.ygyno.2022.04.020] [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: 02/28/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To determine rates of surgical site infection (SSI) with and without an abdominal closure protocol for gynecologic oncology patients undergoing abdominal hysterectomy. METHODS Consecutive patients were identified using CPT codes who underwent total abdominal hysterectomy by gynecologic oncologists at a tertiary care center from January 1, 2015 to December 31, 2019, and stratified by use of the abdominal closure protocol. Demographic, perioperative, and pathologic variables were collected. Fisher's exact and Chi squared tests were used for categorical variables, logistic regression and student t-tests for continuous variables. Multiple logistic regression was used to analyze the relationships between these variables, use of the closure protocol, and development of SSI. RESULTS 739 patients were included over the study period (n = 393 pre-implementation, n = 346 post-implementation of the abdominal closure protocol,). Baseline demographics including ASA score, BMI, diabetes, and smoking were similar between these groups (P = 0.14-0.94). The rate of SSI within 30 days was 5.9% (23/393) in the pre-protocol group and 8.1% (28/346) under the abdominal closure protocol (P = 0.25). On univariate analysis, factors associated with SSI were BMI >40, diabetes, bowel resection, ASA score 3 or 4, hypertension, and contaminated wound class (uOR 2.31-4.09). On multivariate analysis BMI >40, diabetes, and bowel resection remained independent risk factors (aOR 2.27-2.99), with the closure protocol not achieving significance (aOR 1.43, 95% CI 0.79-2.59). There were no potentially high-risk sub-groups in whom the closing protocol showed benefit. CONCLUSION The abdominal closure protocol in isolation did not decrease SSI in those undergoing TAH by a gynecologic oncologist.
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Affiliation(s)
- Joseph A DeMari
- Division of Gynecologic Oncology, Wake Forest School of Medicine, Winston Salem, USA.
| | - Glenn P Boyles
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, USA
| | - David A Barrington
- Division of Gynecologic Oncology, The Ohio State University, Columbus, USA
| | | | - B S Jae Baek
- College of Medicine, The Ohio State University, Columbus, USA
| | - David E Cohn
- Division of Gynecologic Oncology, The Ohio State University, Columbus, USA
| | - Christa I Nagel
- Division of Gynecologic Oncology, The Ohio State University, Columbus, USA
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Lim CY, Alonso A, Koh YY, Roydhouse S, McCormack L, Deans R, Nesbitt-Hawes E, Rao A, Causer L, Abbott JA. A Double-Blinded, Randomised, Placebo-Controlled Trial of Antibiotic Prophylaxis in Elective Non-Hysterectomy Laparoscopic Surgery for Benign Gynaecological Conditions: A Pilot Study. J Minim Invasive Gynecol 2022; 29:992-997. [PMID: 35513301 DOI: 10.1016/j.jmig.2022.04.018] [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: 01/23/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 10/18/2022]
Abstract
STUDY OBJECTIVE To determine the feasibility of a double-blinded randomised, placebo-controlled study in determining the efficacy of antibiotic prophylaxis in preventing postoperative infections (POI) in elective non-hysterectomy laparoscopic procedures for benign gynaecological conditions. DESIGN Double-blinded, randomised, placebo-controlled trial. SETTING University-affiliated tertiary referral hospital in Sydney, Australia. PATIENTS Women over the age of 18 undergoing elective non-hysterectomy laparoscopic procedures for benign gynaecological conditions were eligible for the study and approached. INTERVENTIONS Prior to surgery, participants were randomised to receive either 2g cephazolin or placebo (10ml normal saline) administered by the anaesthetist. Participants and other research staff were blinded to group allocation. MEASUREMENTS AND MAIN RESULTS The primary outcome was study feasibility measured by recruitment rates, compliance rates of drug administration, compliance rates of delivery, maintenance of double blinding and follow-up rates. Secondary outcomes included rate of postoperative infections, length of hospitalisation, re-admission to hospital, unscheduled presentations to healthcare facilities and antibiotic-related reactions. Between February 2019 and March 2021, 170 patients were approached with 117 (68.8%) participants recruited and randomised. The study had a high compliance rate of trial drug delivery (95.7%) and a high follow-up rate (99.1%). CONCLUSION This pilot study has demonstrated feasibility of a large-scale study with a recruitment rate of 68% of patients approached and excellent trial drug delivery and follow-up rates. As anticipated, it is underpowered for identifying clinically significant findings for postoperative infection rates. A large-scale study is appropriate and essential to determine the health-related risks of antibiotic prophylaxis with an emphasis on antimicrobial stewardship. The sample size for a large-scale study is 1678 participants based on infection rates in this pilot study.
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Affiliation(s)
- Claire Yinn Lim
- School of Women's and Children's Health, UNSW Sydney, New South Wales, Australia; The Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Anaïs Alonso
- School of Women's and Children's Health, UNSW Sydney, New South Wales, Australia; The Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Yi Ying Koh
- School of Women's and Children's Health, UNSW Sydney, New South Wales, Australia; The Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Stephanie Roydhouse
- School of Women's and Children's Health, UNSW Sydney, New South Wales, Australia; The Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Lalla McCormack
- School of Women's and Children's Health, UNSW Sydney, New South Wales, Australia; The Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Rebecca Deans
- School of Women's and Children's Health, UNSW Sydney, New South Wales, Australia; The Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Erin Nesbitt-Hawes
- School of Women's and Children's Health, UNSW Sydney, New South Wales, Australia; The Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Archana Rao
- Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Louise Causer
- Kirby Institute, UNSW Sydney, New South Wales, Australia
| | - Jason A Abbott
- School of Women's and Children's Health, UNSW Sydney, New South Wales, Australia; The Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia.
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Puri M, Nain S, Gautam A, Chaudhary V, Jaiswal N, Gs T, Meena D, Singh M, Chopra K, Sharma P, Chhillar E, Verma H, Mahato R. Rational use of antibiotics for major elective gynaecological and obstetrical surgical procedures: quality improvement journey from a tertiary care public facility. BMJ Open Qual 2022; 11:e001438. [PMID: 35545270 PMCID: PMC9092174 DOI: 10.1136/bmjoq-2021-001438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 08/19/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Antibiotic resistance is a global problem. Irrational use of antibiotics is rampant. Guidelines recommend administration of single dose of antibiotic for surgical antimicrobial prophylaxis (SSAP) for elective obstetrical and gynaecological surgeries. However, it is not usually adhered to in practice. Majority of women undergoing elective major gynaecological surgeries and caesarean sections in the department of obstetrics and gynaecology of our tertiary level heavy case load public health facility were receiving therapeutic antibiotics (for 7-10 days) instead of recommended SSAP. Our aim was to increase the SSAP in our setting from a baseline 2.1% to more than 60% within 6 months. METHODS After root cause analysis, we formulated the departmental antimicrobial policy, spread awareness and sensitised doctors and nursing officers regarding antimicrobial resistance and asepsis through lectures, group discussions and workshops. We initiated SSAP policy for elective major surgeries and formed an antimicrobial stewardship team to ensure adherence to policy and follow processes and outcomes. The point of care quality improvement (QI) methodology was used. Percentage of patients receiving SSAP out of all low-risk women undergoing elective surgery was the process indicator and percentage of patients developing surgical site infection (SSI) of all patients receiving SSAP was the outcome indicator. The impact of various interventions on these indicators was followed over time with run charts. RESULTS SSAP increased from a baseline 2.1%-67.7% within 6 months of initiation of this QI initiative and has since been sustained at 80%-90% for more than 2 years without any increase in SSI rate. CONCLUSION QI methods can rapidly improve the acceptance and adherence to evidence-based guidelines in a busy public healthcare setting to prevent injudicious use of antibiotics.
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Affiliation(s)
- Manju Puri
- Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi, India
| | - Shilpi Nain
- Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi, India
| | - Akriti Gautam
- Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi, India
| | - Vidhi Chaudhary
- Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi, India
| | - Nishtha Jaiswal
- Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi, India
| | - Triveni Gs
- Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi, India
| | - Deepika Meena
- Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi, India
| | - Meenakshi Singh
- Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi, India
| | - Kanika Chopra
- Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi, India
| | - Poornima Sharma
- Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi, India
| | - Ekta Chhillar
- Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi, India
| | - Harpreet Verma
- Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi, India
| | - Richa Mahato
- Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi, India
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Benseler A, McDermott CD. Use of Prophylactic Antibiotics to Prevent Urinary Tract Infection After Urodynamic Testing and Cystoscopy in Women: A Practice Pattern Study. Gynecol Obstet Invest 2022; 87:116-123. [PMID: 35354149 DOI: 10.1159/000524266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 03/14/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To determine practice patterns of prescribing prophylactic antibiotics against urinary tract infection (UTI) for urodynamic studies (UDS) and outpatient cystoscopy in women. DESIGN A cross-sectional survey study was conducted of North American female pelvic medicine and reconstructive specialists (FPMRS). METHODS An online survey was used to assess prophylactic prescribing patterns of FPMRS specialists that perform UDS and outpatient cystoscopy. This survey was developed and then electronically disseminated through the American Urogynecologic Society to 699 eligible physicians. RESULTS A total of 138 surveys were completed. Approximately half of physicians did not prescribe any antibiotic prophylaxis for UDS or for cystoscopy (54% and 43%, respectively). For patients with perceived risk factors (recurrent urinary tract infections, immunosuppression, known neurogenic lower urinary tract dysfunction, indwelling catheter use, elevated post void residual/bladder outlet obstruction, genitourinary anomalies, and diabetes), 32% and 41% of physicians prescribed antibiotic prophylaxis for UDS and cystoscopy, respectively. A minority of physicians always prescribed antibiotics for UDS and cystoscopy (13% and 17%, respectively). LIMITATIONS The response rate was a limitation of the study, however, this rate is in keeping with other physician survey studies published within this subspecialty. Selection and response biases may have contributed to the results of this survey study. CONCLUSION There was no uniform approach to urinary tract infection prophylaxis for UDS and outpatient cystoscopy in women which reflects the lack of current guidelines and the low level of evidence on which they are based. This non-uniform practice calls for more research to better define an evidence-based standard of care.
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Affiliation(s)
- Anouk Benseler
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Colleen D McDermott
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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Temtanakitpaisan T, Buppasiri P, Lumbiganon P, Laopaiboon M, Rattanakanokchai S. Prophylactic antibiotics for preventing infection after continence surgery in women with stress urinary incontinence. Cochrane Database Syst Rev 2022; 3:CD012457. [PMID: 35349162 PMCID: PMC8962651 DOI: 10.1002/14651858.cd012457.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Surgical options for treating stress urinary incontinence (SUI) are usually explored after conservative interventions have failed. Surgeries fall into two categories: traditional techniques (open surgery) and minimally invasive procedures, such as laparoscopic procedures, midurethral sling and injections with urethral bulking agents. Postsurgery infections, such as infections of the surgical site or urinary tract, are common complications. To minimise the risk of postoperative bacterial infections, prophylactic antibiotics may be given before or during surgery. OBJECTIVES: To assess the effects of prophylactic antibiotics for preventing infection following continence surgery in women with stress urinary incontinence. SEARCH METHODS: We searched the Cochrane Incontinence Specialised Register, which contains trials identified from CENTRAL, MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, CINAHL, ClinicalTrials.gov and WHO ICTRP; and handsearched journals and conference proceedings to 18 March 2021. We also searched the reference lists of relevant articles. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs assessing prophylactic antibiotics in women undergoing continence surgery to treat SUI. DATA COLLECTION AND ANALYSIS Two review authors selected potentially eligible trials, extracted data and assessed risk of bias. We expressed results as risk ratios (RR) for dichotomous outcomes and as mean differences (MD) for continuous outcomes, both with 95% confidence intervals (CIs). We assessed the certainty of evidence using the GRADE approach. MAIN RESULTS We identified one quasi-RCT and two RCTs, involving a total of 390 women. One study performed retropubic urethropexy surgery requiring a transverse suprapubic incision, while the other two studies performed midurethral sling surgery. It should be noted that none of the included studies clearly specified the timing of outcome assessment. We are very uncertain whether prophylactic antibiotics (cefazolin) have an effect on surgical site infections (RR 0.56, 95% CI 0.03 to 12.35; 2 studies, 85 women; very low-certainty evidence) or urinary tract infections or bacteriuria (RR 0.84, 95% CI 0.05 to 13.24; 2 studies, 85 women; very low-certainty evidence). The effect of prophylactic antibiotics (cefazolin) on febrile morbidity is also uncertain (RR 0.08, 95% CI 0.00 to 1.29; 2 studies, 85 women; very low-certainty evidence). We are very uncertain whether prophylactic antibiotics (cefazolin) have any effect on mesh exposure (RR 0.32, 95% CI 0.01 to 7.61; 1 study, 59 women; very low-certainty evidence). None of the three included studies described the assessment of adverse events from antibiotic use, sepsis or bacteraemia in their reports. AUTHORS' CONCLUSIONS Only limited data are available from the three included studies and, overall, the certainty of evidence was very low. Moreover, the three included studies evaluated different surgical procedures and dosages of antibiotic administration. Thus, there is insufficient evidence to support or refute the use of prophylactic antibiotics to prevent infection following anti-incontinence surgery. In addition, there were no data regarding adverse effects of prophylactic antibiotics. More RCTs are required.
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Affiliation(s)
- Teerayut Temtanakitpaisan
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Pranom Buppasiri
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Pisake Lumbiganon
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Malinee Laopaiboon
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Siwanon Rattanakanokchai
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
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Cowley ES, Jacques L, Powell AM, Al-Niaimi A, Pop-Vicas A. Characterization of bacterial composition of surgical site infections after gynecologic surgery. Am J Obstet Gynecol 2022; 227:345-347. [PMID: 35248576 DOI: 10.1016/j.ajog.2022.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 02/27/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Elise S Cowley
- Department of Bacteriology, University of Wisconsin-Madison, Madison, WI; Microbiology Doctoral Training Program, University of Wisconsin-Madison, Madison, WI
| | - Laura Jacques
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Anna M Powell
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD
| | - Ahmed Al-Niaimi
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI; Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI
| | - Aurora Pop-Vicas
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI.
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Vagina. AORN J 2022; 115:P7-P10. [PMID: 35213049 DOI: 10.1002/aorn.13637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Link T. Guidelines in Practice: Preoperative Patient Skin Antisepsis. AORN J 2022; 115:156-166. [PMID: 35084763 DOI: 10.1002/aorn.13605] [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: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 11/12/2022]
Abstract
Surgical site infections (SSIs) frequently involve resident bacteria (eg, Staphylococcus aureus) on the patient's skin. Strategies to help prevent SSIs include removing soil and transient microorganisms from the skin before surgery. Preoperative decolonization, preoperative bathing, and application of an effective skin antiseptic at the surgical site are components of a multimodal approach to reducing microorganisms to subpathogenic levels. As members of an interdisciplinary team, perioperative RNs are essential in the development and implementation of SSI prevention bundles to promote patient safety. This article discusses recommendations from the AORN "Guideline for preoperative patient skin antisepsis" for decolonization protocols, preoperative bathing, and selection of surgical site antiseptics. A scenario describes the process a facility team uses to determine components of an SSI prevention bundle after recognizing an increase in infections from multidrug-resistant organisms.
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