Bacterial colony counts during vaginal surgery.

Patrick Culligan,Michael Heit,Carol A Graham,James Snyder,Linda Blackwell,Miles Murphy

doi:10.1080/10647440300025515

Patrick Culligan, Michael Heit + Show 4 more

Open Access

https://doi.org/10.1080/10647440300025515

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Abstract

Objective: To describe the bacterial types and colony counts present before and during vaginal surgery. Methods: A descriptive study was undertaken of patients undergoing vaginal hysterectomy with or without reconstructive pelvic surgery. Aerobic and anaerobic bacterial cultures were obtained immediately before and throughout the surgical cases at preselected time intervals. Standard antimicrobial prophylaxis was administered in all cases. Mean total colony counts and mean anaerobic colony counts were determined by adding all colonies regardless of bacteria type. ‘Contamination’ was defined as ≥ 5000 colony-forming units/ml. Results: A total of 31 patients aged 26 to 82 years (mean age ± SD, 51 ± 15) were included. The highest total and anaerobic colony counts were found at the first intraoperative time interval. On the first set of cultures (30 minutes after the surgical scrub), 52% (16/31) of the surgical fields were contaminated, and at 90 minutes, 41% (12/29) were contaminated. A negligible number of subsequent cultures were contaminated. Conclusions: Any future interventions designed to minimize bacterial colony counts should focus on the first 30 to 90 minutes of surgery.

Highlights

Post-hysterectomy wound infections primarily result from the ascending spread of microorganisms from the upper vagina[1]
Preoperative antibiotics were administered between 30 minutes and 2 hours prior to the start of each operation
The alternative antibiotic regimen consisted of 900 mg of clindamycin and 120 mg of gentamicin

Summary

Introduction

Post-hysterectomy wound infections primarily result from the ascending spread of microorganisms from the upper vagina[1]. Prior to the widespread use of prophylactic antibiotics, the rate of wound infection after vaginal hysterectomy was around 30–40%2. This unacceptably high infection rate prompted at least 25 randomized controlled trials and two meta-analyses[3,4], all of which supported the use of prophylactic antibiotics to decrease the infectious morbidity rate and length of hospital stay associated with vaginal hysterectomy.

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