43 Effect of preoperative antibiotic prophylaxis regimen on the rate of surgical site infection after laparoscopic hysterectomy

Abstract

To evaluate the efficacy of preoperative cefazolin alone versus metronidazole with cefazolin versus Jumpily alternative antibiotic regimen with the prevention of postoperative surgical site infection following laparoscopic hysterectomy. This was a retrospective cohort study of adult patients from the Carolina Data Warehouse for Health (a central database with clinical, research, and administrative data) undergoing laparoscopic hysterectomy for benign or malignant indications, 2016-2018. Primary exposure was prophylactic antibiotic regimen of either (1) cefazolin, (2) cefazolin and metronidazole, or (3) alternative antibiotic regimen. Primary outcome was surgical site infection (deep and superficial infections). Multivariable logistic regression was used to examine the association between antibiotic regimen and surgical site infection with adjustment for race, insurance type, and surgical training. Among 445 laparoscopic hysterectomies, 165 received cefazolin, 161 received cefazolin and metronidazole and 119 received an alternate antibiotic regimen. Overall rate of surgical site infection was 4.5%, 1.2% for cefazolin alone (2/165), 6.2% for cefazolin and metronidazole (10/161) and 6.7% for alternative regimens (8/119). Odds ratio of SSI for cefazolin/metronidazole vs cefazolin alone was 5.46 (1.18, 25.3) and upon adjustment decreased to 2.03 (0.36, 11.48). Odds ratio of SSI for other antibiotic regimen vs cefazolin alone was 5.17 (1.06, 25.4) and adjusted 5.01 (0.91, 27.58). We found no difference in surgical site infection rates between antibiotic regimens. The routine addition of metronidazole to cefazolin does not appear to improve infection prophylaxis at the time of laparoscopic hysterectomy.