title: Antibiotic prophylaxis for hysterectomy, a prospective cohort study: cefuroxime, metronidazole, or both?
abstract: OBJECTIVE
  To evaluate cefuroxime and metronidazole antibiotic prophylaxis.
  
  
  METHODS
  Observational nonrandomised 1-year prospective cohort study.
  
  
  METHODS
  Fifty-three hospitals in Finland.
  
  
  METHODS
  A total of 5279 women undergoing hysterectomy for benign indications, with cefuroxime given to 4301 and metronidazole given to 2855. Excluding other antibiotics, cefuroxime alone was given to 2019, metronidazole alone was given to 518, and they were administered in combination to 2252 women.
  
  
  METHODS
  Data on 1115 abdominal hysterectomies (AHs), 1541 laparoscopic hysterectomies (LHs), and 2133 vaginal hysterectomies (VHs) were analysed using logistic regression adjusted for confounding factors.
  
  
  METHODS
  Postoperative infections.
  
  
  RESULTS
  Cefuroxime had a risk-reductive effect for total infections (adjusted odds ratio, OR, 0.29; 95% confidence interval, 95% CI, 0.22-0.39), but the independent effect of metronidazole and the interaction effect of cefuroxime and metronidazole were nonsignificant. In subgroup analyses of AHs, LHs, and VHs involving those receiving the two main antibiotics only, the effect of cefuroxime alone nonsignificantly differed from that of cefuroxime and metronidazole in combination for all types of infection. The absence of cefuroxime, assessed by comparing metronidazole alone with cefuroxime and metronidazole in combination, led to an increased risk for total infections in AHs (adjusted OR 3.63; 95% CI 1.99-6.65), in LHs (OR 3.53; 95% CI 1.74-7.18), and in VHs (OR 4.05; 95% CI 2.30-7.13), and also increased risks for febrile events in all categories (AHs, OR 2.86; 95% CI 1.09-7.46; LHs, OR 13.19; 95% CI 3.66-47.49; VHs, OR 12.74; 95% CI 3.01-53.95), wound infections in AHs (OR 6.88; 95% CI 1.09-7.49), and pelvic infections in VHs (OR 4.26; 95% CI 1.76-10.31).
  
  
  CONCLUSIONS
  In this study, cefuroxime appeared to be effective in prophylaxis against infections. Metronidazole appeared to be ineffective, with no additional risk-reductive effect when combined with cefuroxime.
authors.affiliation: Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: T H I
authors.initials: TH
authors.lastname: Brummer
authors.forename: A-M
authors.initials: AM
authors.lastname: Heikkinen
authors.forename: J
authors.initials: J
authors.lastname: Jalkanen
authors.forename: J
authors.initials: J
authors.lastname: Fraser
authors.forename: J
authors.initials: J
authors.lastname: Mäkinen
authors.forename: E
authors.initials: E
authors.lastname: Tomás
authors.forename: T
authors.initials: T
authors.lastname: Seppälä
authors.forename: J
authors.initials: J
authors.lastname: Sjöberg
authors.forename: P
authors.initials: P
authors.lastname: Härkki
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000517:prevention & control*; D002444:Cefuroxime / Q000627:therapeutic use*; D016001:Confidence Intervals; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000009:adverse effects*; D010535:Laparoscopy; D016015:Logistic Models; D008795:Metronidazole / Q000627:therapeutic use*; D016017:Odds Ratio; D010388:Pelvis; D013530:Surgical Wound Infection / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D002444:Cefuroxime
keywords: Antibiotic prophylaxis; cefuroxime; hysterectomy; metronidazole