Avoiding serious infections associated with abdominal hysterectomy: a meta-analysis of antibiotic prophylaxis.
OBJECTIVE
Our objective was to determine whether the use of preoperative antibiotics prevents serious infections associated with total abdominal hysterectomy.


METHODS
We identified 25 randomized controlled trials of antibiotic prophylaxis that used rigorous protocols. We performed meta-analysis and cumulative meta-analyses for all of the trials, and then we performed separate meta-analysis for cefazolin, metronidazole, and tinidazole.


RESULTS
Overall, 21.1% (373 of 1768) of the patients who did not receive antibiotic prophylaxis had serious infections after abdominal hysterectomy. Among patients who received any antibiotics, we found that 9.0% (166/1836) had serious postoperative infections; among those who received cefazolin, metronidazole, or tinidazole, 11.4% (70 of 615), 6.3% (17 of 269), and 5.0% (5 of 101), respectively, had serious postoperative morbidity. The differences in the prevalence of infection between women who received prophylaxis and women who did not receive prophylaxis were statistically significant (any antibiotics, p = 0.00001; cefazolin, p = 0.00021; metronidazole, p = 0.015; and tinidazole, p = 0.034).


CONCLUSIONS
Because preoperative antibiotics are highly effective in the prevention of serious infections associated with total abdominal hysterectomy, we believe they should be used routinely. In addition, we believe that the use of controls who receive no treatment is no longer justified in trials of antibiotic prophylaxis for total abdominal hysterectomy.
Mittendorf
R
R
Department of Obstetrics and Gynecology, University of Chicago, IL.
Aronson
M P
MP
Berry
R E
RE
Williams
M A
MA
Kupelnick
B
B
Klickstein
A
A
Herbst
A L
AL
Chalmers
T C
TC
D000005:Abdomen / Q000601:surgery*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002437:Cefazolin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D008795:Metronidazole / Q000627:therapeutic use; D011247:Pregnancy; D015995:Prevalence; D016032:Randomized Controlled Trials as Topic; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*; D014011:Tinidazole / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D014011:Tinidazole; D008795:Metronidazole; D002437:Cefazolin