Infection after radical abdominal hysterectomy and pelvic lymphadenectomy: prevention of infection with a two-dose peri-operative antibiotic prophylaxis

Surgical site-related infections occurred in 21% of 87 consecutive patients undergoing radical hysterectomy with pelvic lymphadenectomy (RHPL) without planned peri-operative prophylaxis. A prospective, randomized double-blind, placebo-controlled study was conducted in 68 consecutive RHPL patients. In the 32 available patients with two-dose cefuroxime and metronidazole prophylaxis no surgical site-related infections developed as opposed to a rate of 14% in the 28 patients in the placebo group ( P < 0.05). In a prospective, randomized double-blind study two two-dose antibiotic prophylactic regimens were compared in 105 consecutive patients. Surgical site-related infections developed in one (2%) patient in the cefuroxime plus metronidazole group, and in six (12%) patients in the moxalactam group. This difference did not achieve statistical significance. The mean length of the postoperative hospital stay of the patients with scheduled surgical prophylaxis was significantly shorter ( P < 0.01) than that of the patients operated on without surgical prophylaxis. A two-dose antibiotic regimen is recommended, because levels of antibiotics assayed in samples collected during the course of the operation indicated a rapid clearance of the antibiotics from the operative site, most likely due to the high volume of peri-operative blood loss.