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

Published online by Cambridge University Press:  05 December 2018

Aurora Pop-Vicas ,
Stephen Johnson  and
Nasia Safdar
Aurora Pop-Vicas*
Affiliation:
Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Stephen Johnson
Affiliation:
Ebling Library for the Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Nasia Safdar
Affiliation:
Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin William S. Middleton Memorial Veterans Affairs Hospital, Madison, Wisconsin
*
Author for correspondence: Aurora Pop-Vicas, MD, MPH, Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave, 5th floor, Madison, WI 53705. E-mail: [email protected]
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Abstract

Objective

Current 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.

Methods

We 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.

Results

In 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.

Conclusion

Due 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.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 2 , February 2019 , pp. 142 - 149
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

Cite this article: Pop-Vicas A, et al. (2019). Cefazolin as surgical antimicrobial prophylaxis in hysterectomy: A systematic review and meta-analysis of randomized controlled trials. Infection Control & Hospital Epidemiology 2019, 40, 142–149. doi: 10.1017/ice.2018.286

References

1. Anderson, DJ, Podgorny, K, Berrios-Torres, SI, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35 Suppl 2:S66–S88.Google Scholar
2. Berrios-Torres, SI, Umscheid, CA, Bratzler, DW, et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg 2017;152:784–791.Google Scholar
3. Centers for Medicare and Medicaid Services HHS. Medicare and Medicaid programs: hospital outpatient prospective payment and ambulatory surgical center payment systems and quality reporting programs; Hospital Value-Based Purchasing Program; organ procurement organizations; quality improvement organizations; Electronic Health Records (EHR) Incentive Program; provider reimbursement determinations and appeals. Final rule with comment period and final rules. Fed Regist 2013;78:74825–75200.Google Scholar
4. Horan, TC, Gaynes, RP, Martone, WJ, Jarvis, WR, Emori, TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992;13:606–608.Google Scholar
5. Dellinger, EP, Gross, PA, Barrett, TL, et al. Quality standard for antimicrobial prophylaxis in surgical procedures. The Infectious Diseases Society of America. Infect Control Hosp Epidemiol 1994;15:182–188.Google Scholar
6. Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1999;20:250–278.Google Scholar
7. Roy, S, Patkar, A, Daskiran, M, Levine, R, Hinoul, P, Nigam, S. Clinical and economic burden of surgical site infection in hysterectomy. Surg Infect (Larchmt) 2014;15:266–273.Google Scholar
8. Bulletins—Gynecology ACoP. ACOG practice bulletin No. 104: antibiotic prophylaxis for gynecologic procedures. Obstet Gynecol 2009;113:1180–1189.Google Scholar
9. Mittendorf, R, Aronson, MP, Berry, RE, et al. Avoiding serious infections associated with abdominal hysterectomy: a meta-analysis of antibiotic prophylaxis. Am J Obstet Gynecol 1993;169:1119–1124.Google Scholar
10. Duff, P. Antibiotic prophylaxis for abdominal hysterectomy. Obstet Gynecol 1982;60:25–29.Google Scholar
11. Bratzler, DW, Dellinger, EP, Olsen, KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt) 2013;14:73–156.Google Scholar
12. Liberati, A, Altman, DG, Tetzlaff, J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med 2009;151:W65–W94.Google Scholar
13. Guyatt, GH, Oxman, AD, Vist, G, et al. GRADE guidelines: 4. Rating the quality of evidence–study limitations (risk of bias). J Clin Epidemiol 2011;64:407–415.Google Scholar
14. Higgins, JP, Thompson, SG, Deeks, JJ, Altman, DG. Measuring inconsistency in meta-analyses. BMJ 2003;327:557–560.Google Scholar
15. Sterne, JA, Egger, M. Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. J Clin Epidemiol 2001;54:1046–1055.Google Scholar
16. Egger, M, Davey Smith, G, Schneider, M, Minder, C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315:629–634.Google Scholar
17. Baldoni, A, Cosco, AG, Epicoco, G, Affronti, G, Giannone, E, Gilardi, G. Comparative study of short-term antimicrobial chemoprophylaxis in gynecologic surgery: cefotetan versus cefazolin. Minerva Ginecol 1989;41:149–155.Google Scholar
18. Periti, P, Mazzei, T, Periti, E. Prophylaxis in gynaecological and obstetric surgery: a comparative randomised multicentre study of single-dose cefotetan versus two doses of cefazolin. Chemioterapia 1988;7:245–252.Google Scholar
19. Periti, P, Mazzei, T, Orlandini, F, Mini, E. Comparison of the antimicrobial prophylactic efficacy of cefotaxime and cephazolin in obstetric and gynaecological surgery. A randomised multicentre study. Drugs 1988;35 Suppl 2:133–138.Google Scholar
20. Cormio, G, Di Fazio, F, Cacciapuoti, C, Bettocchi, S, Borraccino, L, Selvaggi, L. Prospective randomized study comparing amoxicillin-clavulanic acid with cefazolin as antimicrobial prophylaxis in laparotomic gynecologic surgery. Acta Obstet Gynecol Scand 2003;82:1130–1134.Google Scholar
21. Grossman, JH 3rd, Greco, TP, Minkin, MJ, Adams, RL, Hierholzer, WJ Jr, Andriole, VT. Prophylactic antibiotics in gynecologic surgery. Obstet Gynecol 1979;53:537–544.Google Scholar
22. Hemsell, DL, Johnson, ER, Hemsell, PG, Nobles, BJ, Little, BB, Heard, MC. Cefazolin is inferior to cefotetan as single-dose prophylaxis for women undergoing elective total abdominal hysterectomy. Clin Infect Dis 1995;20:677–684.Google Scholar
23. Stiver, HG, Binns, BO, Brunham, RC, et al. Randomized, double-blind comparison of the efficacies, costs, and vaginal flora alterations with single-dose ceftriaxone and multidose cefazolin prophylaxis in vaginal hysterectomy. Antimicrob Agent Chemother 1990;34:1194–1197.Google Scholar
24. Jyothi, S, Vyas Neetha, M, Pratap, K, Asha, K. Antibiotic prophylaxis for hysterectomy and cesarean section: amoxicillin-clavulanic acid versus cefazolin. J Obstet Gynecol India 2010;60:419–423.Google Scholar
25. Phoolcharoen, N, Nilgate, S, Rattanapuntamanee, O, Limpongsanurak, S, Chaithongwongwatthana, S. A randomized controlled trial comparing ceftriaxone with cefazolin for antibiotic prophylaxis in abdominal hysterectomy. Int J Gynaecol Obstet 2012;119:11–13.Google Scholar
26. Fagotti, A, Costantini, B, Fanfani, F, et al. Risk of postoperative pelvic abscess in major gynecologic oncology surgery: one-year single-institution experience. Ann Surg Oncol 2010;17:2452–2458.Google Scholar
27. Faro, C, Faro, S. Postoperative pelvic infections. Infect Dis Clin North Am 2008;22:653–663.Google Scholar
28. Lachiewicz, MP, Moulton, LJ, Jaiyeoba, O. Pelvic surgical site infections in gynecologic surgery. Infect Dis Obstet Gynecol 2015;2015:614950.Google Scholar
29. Soper, DE. Bacterial vaginosis and postoperative infections. Am J Obstet Gynecol 1993;169:467–469.Google Scholar
30. Soper, DE, Bump, RC, Hurt, WG. Bacterial vaginosis and trichomoniasis vaginitis are risk factors for cuff cellulitis after abdominal hysterectomy. Am J Obstet Gynecol 1990;163:1016–1021.Google Scholar
31. Till, SR, Morgan, DM, Bazzi, AA, et al. Reducing surgical site infections after hysterectomy: metronidazole plus cefazolin compared with cephalosporin alone. Am J Obstet Gynecol 2017;217:187 e181–187 e187.Google Scholar
32. Uppal, S, Harris, J, Al-Niaimi, A, et al. Prophylactic antibiotic choice and risk of surgical site infection after hysterectomy. Obstet Gynecol 2016;127:321–329.Google Scholar
33. Ayeleke, RO, Mourad, S, Marjoribanks, J, Calis, KA, Jordan, V. Antibiotic prophylaxis for elective hysterectomy. Cochrane Database Syst Rev 2017;6:CD004637.Google Scholar
34. Wttewaall-Evelaar, EW. Meta-analysis of randomized controlled trials of antibiotic prophylaxis in abdominal hysterectomy. Pharmaceutisch weekblad Sci ed. 1990;12:296–298.Google Scholar
35. Tanos, V, Rojansky, N. Prophylactic antibiotics in abdominal hysterectomy. J Am Coll Surg 1994;179:593–600.Google Scholar
36. Chongsomchai, C, Lumbiganon, P, Thinkhamrop, J, Ounchai, J, Vudhikamraksa, N. Placebo-controlled, double-blind, randomized study of prophylactic antibiotics in elective abdominal hysterectomy. J Hosp Infect 2002;52:302–306.Google Scholar
37. Hemsell, DL, Menon, MO, Friedman, AJ. Ceftriaxone or cefazolin prophylaxis for the prevention of infection after vaginal hysterectomy. Am J Surg 1984;148(4a):22–26.Google Scholar
38. Hemsell, DL, Johnson, ER, Bawdon, RE, Hemsell, PG, Nobles, BJ, Heard, ML. Ceftriaxone and cefazolin prophylaxis for hysterectomy. Surg Gynecol Obstet 1985;161:197–203.Google Scholar
39. Hemsell, DL, Bawdon, RE, Hemsell, PG, Nobles, BJ, Johnson, ER, Heard, MC. Single-dose cephalosporin for prevention of major pelvic infection after vaginal hysterectomy: cefazolin versus cefoxitin versus cefotaxime. Am J Obstet Gynecol 1987;156:1201–1205.Google Scholar
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