Postoperative infections and antibiotic prophylaxis for hysterectomy in Sweden: a study by the Swedish National Register for Gynecologic Surgery.
OBJECTIVE
The purpose of the study was to evaluate the current use of antibiotic prophylaxis, the rate of postoperative infections, and risk factors for postoperative infections in patients undergoing elective hysterectomy for non-malignant pathology.


METHODS
The study was performed during the time period July 2000 to 1 January 1 2003, using data from the Swedish National Register for Gynecologic Surgery, covering 26 of 49 clinics and approximately 50% of the Swedish population. During this time period, 3267 women undergoing elective hysterectomy for non-malignant pathology (mainly dysfunctional bleeding and fibromas) and with complete data on the use of antibiotic prophylaxis and postoperative follow up were included. A postoperative infection was considered to have developed if patients or the physician reported an infection related to the surgical site, together with reported use of antibiotic treatment.


RESULTS
Among the 3267 patients, 341 (10.4%) were considered to have developed a postoperative infection. In cases where antibiotic prophylaxis had not been given, total abdominal hysterectomies and vaginal hysterectomies were associated with the highest frequency for postoperative infections P < 0.05 and P < 0.01, respectively. Notably, also women undergoing subtotal hysterectomy reported significantly lower rates of postoperative infections if prophylactic antibiotics had been given, P < 0.05. Risk factors for postoperative infection were non-use of antibiotic prophylaxis, hospital, age less than 40 years, and BMI > 30 kg/m(2).


CONCLUSIONS
The study results have indicated the need of prospective clinical trials on antibiotic prophylaxis for patients undergoing supravaginal abdominal hysterectomy. Also, a need to further evaluate the current prophylactic antibiotic protocols used for obese patients and younger women undergoing any kind of hysterectomy is warranted.
Löfgren
Mats
M
Department of Clinical Science, Obstetrics and Gynecology, Umeå University Hospital, Umeå, Sweden.
Poromaa
Inger Sundström
IS
Stjerndahl
Jan Henrik
JH
Renström
Birgitta
B
D000328:Adult; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data; D015992:Body Mass Index; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data*; D007045:Hysterectomy, Vaginal / Q000706:statistics & numerical data; D008875:Middle Aged; D012042:Registries; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000517:prevention & control
D000900:Anti-Bacterial Agents