Perioperative Use of Antimicrobials in Gynecology: Results of Pharmacoepidemiological Study

Clinical Microbiology and Antimicrobial Chemotherapy. 2003; 5(3):285-292

​ Petrov V.I., Ershov G.V., Kovaleva Yu.S., Bochkarev D.N., Tchernavin A.V., Alekseeva Ya.G.
gynecology surgical site infection antimicrobial prophylaxis hysterectomy antibiotics
Section
Pharmacoepidemiology
Type
Journal article
Publication
Clinical Microbiology and Antimicrobial Chemotherapy. 2003; 5(3):285-292

Abstract

The aim of study was to identify patterns of perioperative use of antimicrobials in patients undergo, ing hysterectomy and to study surgical site infection (SSI) rates in this category of patients. The medical records of 600 women who underwent hysterectomy (mean age 46,8±1,2 years) in 3 gynecological hospitals in Volgograd were analysed. Risk factors for SSI, choice of antimicrobials for periop, erative prophylaxis, its regimen and duration were assessed. There were three groups of patients: group 1 (n = 79) – «shortest» preoperative course of prophylactic antimicrobials; group 2 (n = 64) – intra-operative intravenous administration of antibiotic in combination with postoperative short course of therapeutic antimicrobials; group 3 (n = 457) – «preventive» antimicrobial therapy which begins after 24 h following surgery and lasts 5–7 days. Efficacy of antimicrobial prophylaxis was evaluated by SSI rates and length of postoperative hospital stay. Risk factors for SSI were determined in 449 (74,8%) patients. In groups 1 and 2 the most commonly used prophylactic antimicrobials were cefazolin (75,9 and 56,3%) and cefotaxime (24,1 and 43,7%). In the group 2, 54,7% of patients received postoperatively the same antibiotic as for preoperative prophylaxis; in the rest 45,3% of patients antimicrobial regimen was changed. In group 3, second, or third,generation aminoglycosides (31,2%), cefazolin (17,5%), ampicillin (14,0%) were common «preventive» therapeutic antimicrobials. The combinations of antibiotics were administered to 18,7% of patients in the group 3. There have been reported 49 (8,1%) cases of SSI. All SSI cases were observed in the group 3 patients, i. e. in patients not receiving antimicrobial prophylaxis. Perioperative antimicrobial prophylaxis hasn’t shown to be routinely performed in 86,8% of patients undergoing hysterectomy in Volgograd. «Preventive» antimicrobial therapy in postoperative period is common practice, which is not justified. In 10,7% of cases antimicrobial prophylaxis is administered in combination with the postoperative course of therapeutic antimicrobials (5–7 days). Choice of prophylactic antibiotics doesn’t comply with current international recommendations.

  • 1. Whitehouse J.D., Sexton D.J., Kirkland K.B. Infection control: past, present, and future issues. Compr Ther 1998;24:71-7.
  • 2. Central Public Health Laboratory. Surgical Site Infection. Analysis of Year’s Surveillance in English Hospitals, 1997–98. Available from www.phls.org.uk
  • 3. Beam T.R., Gilbert D.N., Kunin С.М., editors. Европейское руководство по клинической оценке противоинфекционных лекарственных средств. Смоленск: Амипресс; 1996.
  • 4. Scottish Intercollegiate Guidelines Network (SIGN). SIGN guidelines: an introduction to SIGN methodology for the development of valid evidence based clinical guidelines. Edinburgh; 2000.
  • 5. Антибиотикопрофилактика в хирургии: Методические рекомендации. Под ред. В.К. Гостищева. Москва; 1997.
  • 6. Зубков М.Н., Чегин В.М., Зубков М.М. Современные принципы антибиотикопрофилактики хирургических инфекций. Кремлевская мед. Клин вестн 2000; 2. Available from www.pmc.ru:8101/publ
  • 7. Краснопольский В.И., Буянова С.Н., Щукина Н.А. Гнойная гинекология. Москва: Медпресс; 2001.
  • 8. Страчунский Л.С., Белоусов Ю.Б., Козлов С.Н. Практическое руководство по антиинфекционной химиотерапии. Москва: Боргес; 2002.
  • 9. Яковлев С.В., Яковлев В.П. Современная антимикробная терапия в таблицах. Consilium Medicum 2001;3(1):4-50.
  • 10. Gilbert D.N., Moellering R.C., Sande M.A., editors. The Sanford Guide to Antimicrobial Therapy. 33th ed. Hyde Park (VT): Antimicrobial Therapy, Inc; 1999.
  • 11. Омельяновский В.В., Щукина Н.А., Буянова С.Н. Основные принципы антибиотикопрофилактики в гинекологии. Вестн рос ассоц акушеров-гинекологов 1999;3:90-4.
  • 12. Фомина И.П., Смирнова Л.Б., Гельфанд Е.Б. Антибиотики в профилактике хирургической инфекции. Антибиотики и химиотер 1998;43(9):35-43.
  • 13. The Hospital Infection Control Practices Advisory Committee. Guideline for Prevention of Surgical Site Infection, 1999. Infect Control Hosp Epidemiol 1999;20:247-78.
  • 14. Classen D.C., Evans R.S., Pestotnik S.L., et al. The timing of prophylactic administration of antibiotics and the risk of surgical wound infection. N Engl J Med 1992;326: 281-6.
  • 15. Woods R.K., Dellinger E.P. Current guidelines for antibiotic prophylaxis of surgical wounds. Am Fam Physician 1998; 57(11):2731-40.
Views
0 Abstract
0 PDF
0 Crossref citations
Shared