Preventing major operative site infection after radical abdominal hysterectomy and pelvic lymphadenectomy.
Twenty-one women who underwent radical abdominal hysterectomy and pelvic lymphadenectomy were enrolled in a prospective, comparative, randomized, placebo-controlled clinical trial of antimicrobial prophylaxis. Preoperative endocervical flora was identified and was similar in pre- and postmenopausal private and clinic service women; 46% of the 119 preoperative isolates produced beta-lactamase enzyme. Women were given three doses of either placebo or cefoperazone plus sulbactam, an irreversible beta-lactamase enzyme inhibitor. Three women (27%) given placebo developed abdominal incision infections; one women given placebo also developed a pelvic infection. None given antibiotic developed operative site infection, but one women developed a drain site infection. A major operative site infection rate of 27% observed with placebo is high enough to warrant prophylaxis. Although antimicrobial prophylaxis at radical hysterectomy and pelvic lymphadenectomy eradicted operative site infection in our patient populations, a literature review indicates that individual determination of a requirement for prophylaxis is necessary.
Hemsell
D L
DL
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Parkland Memorial Hospital, Dallas, Texas.
Bernstein
S G
SG
Bawdon
R E
RE
Hemsell
P G
PG
Heard
M C
MC
Nobles
B J
BJ
D000328:Adult; D001419:Bacteria / Q000201:enzymology; D002438:Cefoperazone / Q000032:analysis / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007262:Infusions, Intravenous; D008197:Lymph Node Excision; D008875:Middle Aged; D011292:Premedication; D011446:Prospective Studies; D011897:Random Allocation; D013407:Sulbactam / Q000032:analysis / Q000627:therapeutic use*; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control*; D002583:Uterine Cervical Neoplasms / Q000601:surgery; D001618:beta-Lactamases / Q000378:metabolism
D002438:Cefoperazone; D001618:beta-Lactamases; D013407:Sulbactam