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Antibiotic prophylaxis for hysterectomy: cefuroxime, metronidazole or both?

The purpose of a prospective, non-randomized observational cohort study in the Department of Obstetrics and Gynecology at the University Hospital Center Helsinki (University Hospital Center Helsinki, Finland) was to assess the efficacy of cefuroxime as antibiotic prophylaxis for hysterectomy. The duration of the study was 1 year. In total, the study included 5,279 women who underwent a hysterectomy for indications that did not include cancer. Cefuroxime was prescribed to 4301 patients, metronidazole - 2855. With the exception of other antimicrobial drugs, it turned out that only 2019 women received cefuroxime, 518 patients only metronidazole and 2252 women received these 2 drugs in association.

During the work using the logistic regression method, taking into account the potential interference factors, the data were analyzed on 1115 abdominal hysterectomies, 1541 laparoscopic hysterectomies and 2133 vaginal hysterectomies.

The main endpoint evaluated during the study was the incidence of postoperative infections.

Cefuroxime has been shown to reduce the risk of developing infectious complications in general (correlated odds ratio 0.29, 95% confidence interval [CI] 0.22-0.39), while the effects use of metronidazole alone or a combination of cefuroxime + metronidazole were negligible.

In a subgroup analysis for various types of hysterectomies, including patients who received 2 main antibiotics as monotherapy, it was found that the effect of monoprophylaxis with cefuroxime was not statistically significantly different from the combination of cefuroxime + metronidazole for all types of infection.

In the absence of cefuroxime in the prophylactic regimens (the evaluation was carried out by comparing monoprophylaxis with metronidazole and the combination of cefuroxime + metronidazole), it was found to negatively affect the incidence of infections. Thus, the overall frequency of infectious complications with abdominal hysterectomies increases (the correlated odds ratio is 3.63, 95% CI 1.99-6.65), laparoscopic hysterectomies (OR 3.53, 95% CI % 1.74-7.18) and with vaginal hysterectomies (OR 4.05, 95% CI 2.30-7.13), In addition, there was an increased risk of febrile episodes for all categories of patients (with abdominal hysterectomies OR 2.86, 95% CI 1.09-7, 46; laparoscopic SST hysterectomies 13.19, 95% CI 3.66-47.49; vaginal hysterectomies of SST 12.74, CI 95% 3.01-53.95), as well as the risk of pelvic infections with vaginal sterektomii g (OR 4.26, 95% CI 1.76-10.31).

Thus, in this study, cefuroxime proved to be the most effective antibiotic in the prevention of infectious complications during uterine ablation surgery. Prophylactic use of metronidazole is ineffective and the appointment of a combination of cefuroxime + metronidazole does not provide additional benefits to reduce the risk of developing infectious complications.