Prospective randomized study comparing amoxicillin‐clavulanic acid with cefazolin as antimicrobial prophylaxis in laparotomic gynecologic surgery

Cormio, Gennaro; Fazio, Franco Di; Cacciapuoti, Cinzia; Bettocchi, Stefano; Borraccino, L.; Selvaggi, Luigi

doi:10.1046/j.1600-0412.2003.00236.x

Cited by 11 publications

(12 citation statements)

References 8 publications

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“…None of the studies specified whether antimicrobial dosing was adjusted based on patient's weight/body mass index and/or renal clearance, although 2 studies did specify antimicrobial redosing intraoperatively for extensive blood loss or surgery duration > 3 hours. 20,24 Clinical outcome definitions and reporting Definitions and reporting for the clinical outcome of our interest, SSI, were generally consistent between studies. They included the following terms: surgical wound infection, vaginal cuff infection, postoperative vaginal wound infection, infected pelvic abscess or hematoma, pelvic infection requiring parenteral antimicrobial therapy, abdominal wound infection, pelvic cellulitis.…”

Section: Antimicrobial Prophylaxis Characteristicsmentioning

confidence: 76%

Cefazolin as surgical antimicrobial prophylaxis in hysterectomy: A systematic review and meta-analysis of randomized controlled trials

Pop-Vicas

Johnson²,

Safdar

2018

Infect. Control Hosp. Epidemiol.

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ObjectiveCurrent practice guidelines recommend cefazolin, cefoxitin, cefotetan, or ampicillin-sulbactam as first-line antibiotic prophylaxis in hysterectomy. We undertook this systematic review and meta-analysis of randomized controlled trials (RCTs) to determine whether cefazolin, with limited antianaerobic spectrum, is as effective in preventing surgical site-infection (SSI) as the other first-choice antimicrobials that have more extensive antianaerobic activity.MethodsWe searched PubMed, Scopus, Web of Science, Cochrane Central, and EMBASE for relevant randomized controlled trials (RCT) in any language up to January 23, 2018. We only included trials that measured SSI (our primary outcome) defined as superficial, deep, or organ space. We excluded trials of β-lactams no longer in clinical use.ResultsIn terms of SSI incidence, cefazolin use was not inferior to its comparator in 12 of 13 individual RCTs included in the analysis. The meta-analysis summary estimate showed a significantly higher SSI risk with cefazolin versus cefoxitin or cefotetan (risk ratio, 1.7; 95% CI, 1.04–2.77; P = .03). However, most studies included nonstandardized dosing and duration of antimicrobial prophylaxis, had indeterminate or high risk of bias, did not include patients with gynecological malignancies, and/or were older RCTs not reflective of current clinical practices.ConclusionDue to inherent limitations associated with old RCTs with limited relevance to contemporary surgery, an RCT of cefazolin versus regimens with significant antianaerobic spectrum is needed to establish the optimal choice for SSI prevention in hysterectomy.

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Section: Antimicrobial Prophylaxis Characteristicsmentioning

confidence: 76%

Cefazolin as surgical antimicrobial prophylaxis in hysterectomy: A systematic review and meta-analysis of randomized controlled trials

Pop-Vicas

Johnson²,

Safdar

2018

Infect. Control Hosp. Epidemiol.

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“…24,25 A single antibiotic was preferred to a combination, provided that its spectrum included fecal bacterial flora. 26 Amoxicillinclavulanate potassium, 2 g/200 mg, was administered intravenously and repeated 4 hours after the first dose if surgery was prolonged. In the case of allergy to penicillin, metronidazole hydrochloride, 1500 mg, and gentamicin sulfate, 240 mg, were administered in a single intravenous dose.…”

Section: Evidence-based Preventive Measuresmentioning

confidence: 99%

Surgical Site Infection in Elective Operations for Colorectal Cancer After the Application of Preventive Measures

Serra‐Aracil

García-Domingo²,

Parés³

et al. 2011

Arch Surg

117

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“…Las histerectomías constituyen la principal intervención ginecológica en países desarrollados [4,5] y la segunda cirugía más frecuente en mujeres en edad reproductiva tras las cesáreas [6,7]. A pesar de las mejoras en los últimos años, la ILQ en esta cirugía sigue afectando en torno a un 2,7% de las pacientes [3,6,8] y supone un aumento de la estancia hospitalaria media de entre 3 a 5 veces, multiplicando por 3 el riesgo de reingreso y por 2 el riesgo de mortalidad y los costes sanitarios, siendo la infección nosocomial con mayor coste [6,7,9,10].…”

Section: Introductionunclassified

Evaluation of compliance with the antibiotic prophylaxis protocol in hysterectomy. Prospective cohort study

Gil-Conesa¹,

Del-Moral-Luque²,

Climent-Martínez³

et al. 2020

Rev Esp Quimioter

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Objectives. Health care-related infections are a public health problem, among them surgical site infection (SSI) are the most frequent in hospitals. The objetive of this study was to assess the effect of the compliance to antibiotic prophylaxis protocol on the incidence of surgical site infection in hysterectomized patients. Material and methods. A prospective cohort study was carried out between October 2009 and December 2018. The incidence of SSI was studied after a maximum period of 30 days from the moment of surgery. The degree of adequacy of antibiotic prophylaxis in hysterectomy and the effect of its inadequacy on the incidence of infection was evaluated using relative risk (RR) adjusted with a logistic regression model. Results. A total of 1,025 interventions were studied in 1,022 women. The cumulative incidence of SSI was 2,1% (n = 22). The most frequent etiology of infection was Escherichia coli (23.1%) and Proteus mirabilis (23.1%). Antibiotic prophylaxis was indicated in 1,014 interventions (98.9%) being administered in 1,009 of them (99.5%). The adherence to the protocol was 92,5%. The main cause of non-compliance was the time of onset (40.9%), followed by the choice of the antibiotic (35.2%). The effect of inadequate prophylaxis on the incidence of infection was RR = 0.9; 95% CI 0.2-3.9; p> 0.05. Conclusions. The adequacy of antibiotic prophylaxis was very high, with a low incidence of surgical site infection. No association was found between adequacy of prophylaxis and incidence of infection in hysterectomy. The continuous improvement of epidemiological surveillance in gynecology should be emphasized.

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Prospective randomized study comparing amoxicillin‐clavulanic acid with cefazolin as antimicrobial prophylaxis in laparotomic gynecologic surgery

Abstract: Ultra-short-term prophylaxis with both amoxicillin-clavulanic acid and cefazolin is safe in elective laparotomic gynecologic surgery.

Cited by 11 publications

References 8 publications

Cefazolin as surgical antimicrobial prophylaxis in hysterectomy: A systematic review and meta-analysis of randomized controlled trials

Cefazolin as surgical antimicrobial prophylaxis in hysterectomy: A systematic review and meta-analysis of randomized controlled trials

Surgical Site Infection in Elective Operations for Colorectal Cancer After the Application of Preventive Measures

Evaluation of compliance with the antibiotic prophylaxis protocol in hysterectomy. Prospective cohort study

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