A Single Institution Review of Appropriateness of Prophylactic Antibiotics in Hysteroscopy [9M

Abstract

INTRODUCTION: To examine our institution's adherence to American College of Obstetricians and Gynecologists guidelines for antibiotic prophylaxis in gynecologic surgeries for which antibiotics are not recommended. METHODS: A cross-sectional study of hysteroscopy cases performed at a single tertiary care center from August 2011 to September 2015 was completed. Descriptive statistics summarized patient characteristics. Chi-square tests examined antibiotic use associated with categorical variables; t- test was used for continuous variables. Multiple logistic regressions analyzed the effects of variables on the odds of receiving antibiotics of unproven benefit. RESULTS: Among 1,075 women who underwent hysteroscopic procedures for which antibiotics are not recommended, 196 (18.23%) received antibiotics. 770 (71.62%) women had a hysteroscopy alone, and 305 (28.37%) women had additional procedure(s) that also did not warrant antibiotics. The mean age was 45 (SD 13, Range 18-88) years. The odds of having unproven antibiotics increased by 2 percent (OR 1.02) with every one year age increase, adjusted for primary procedure, diagnosis and length of stay [95% CI, 1.76-4.58]. Age (P < .0045), primary procedure (P < .0022), primary diagnosis (P < .0019), admitted year (P < .0302) and length of stay (P < .0005) had statistically significant effects on the impact of having unproven antibiotics. Patients undergoing hysteroscopic ablation were 2.8 times more likely to receive antibiotics than hysteroscopic biopsy (P < .0001). CONCLUSION: Non-indicated antibiotic use is high among gynecologic surgeons at our tertiary hospital and the use varies significantly with patient characteristics. This study supports close surveillance of antibiotic administration during gynecologic surgeries for which the drugs are of unproven benefit.