Prophylactic Antibiotics for Abdominal Hysterectomy: Indication for Low-Risk Canadian Women

Abstract

Objective: To determine whether prophylactic antibiotics decrease the risk of infectious morbidity after total abdominal hysterectomy (TAH) in women at low risk for infection.Methods: An analysis of data from 1570 women undergoing planned TAH at 15 secondary and tertiary hospitals in Nova Scotia, Ontario, and Quebec, who agreed to participate in a centrally randomized controlled trial of vaginal antisepsis with povidone-iodine gel compared to no gel after the standard preoperative vaginal preparation with povidone-iodine solution.Results: Prophylactic antibiotics were used in 993 of 1570 women (63%). Appropriately timed prophylactic antibiotics decreased infectious morbidity (odds ratio [OR], 0.65; 95% confidence interval [Cl], 0.50–0.85; P < .002). After controlling for risk factors for infection and study centre, the protective effect was even more pronounced (adjusted OR, 0.51; 95% Cl, 0.36–0.73). Prophylactic antibiotics were associated with decreases in abdominal wound infection (OR, 0.45; 95% Cl, 0.30–0.66) and pelvic infection (OR, 0.49; 95% Cl, 0.26–0.92).Conclusion: Women who did not receive prophylactic antibiotics had a higher surgical infection rate. Prophylactic antibiotics should be recommended for all women undergoing TAH.