Clifford Vanessa, Daley Andrew
Department of Microbiology, The Royal Children's Hospital, Melbourne, Vic., Australia.
Aust N Z J Obstet Gynaecol. 2012 Oct;52(5):412-9. doi: 10.1111/j.1479-828X.2012.01460.x. Epub 2012 Jul 16.
Surgical site infections are a common complication of obstetric and gynaecological surgeries; up to 10% of gynaecological patients undergoing an operative procedure will develop a surgical site infection. In surgeries with high rates of post-operative infection, antibiotic prophylaxis (using an antibiotic with an appropriate microbiological spectrum and administered in a timely manner) can play a major role in improving outcomes. This review examines the medical literature to assess the indications and appropriate antibiotic choices for prophylaxis to prevent surgical site infection in obstetric and gynaecological surgery. For some procedures, such as caesarean section, surgical termination of pregnancy and hysterectomy, antibiotic prophylaxis is clearly indicated. For other procedures, such as insertion of an intrauterine device, medical termination of pregnancy and laparoscopy, antibiotic prophylaxis is usually not required. For several other procedures where the evidence for antibiotic prophylaxis is unclear or inadequate, we discuss the current evidence for and against prophylaxis. Guidelines for infective endocarditic prophylaxis with surgery are also discussed.
手术部位感染是妇产科手术常见的并发症；高达10%接受手术治疗的妇科患者会发生手术部位感染。在术后感染率较高的手术中，抗生素预防（使用具有适当微生物谱且及时给药的抗生素）对改善预后可发挥重要作用。本综述查阅医学文献，以评估妇产科手术预防手术部位感染的预防指征和合适的抗生素选择。对于某些手术，如剖宫产、人工终止妊娠和子宫切除术，抗生素预防有明确指征。对于其他手术，如宫内节育器置入、药物流产和腹腔镜检查，通常不需要抗生素预防。对于其他一些抗生素预防证据不明确或不充分的手术，我们讨论了支持和反对预防的现有证据。还讨论了手术感染性心内膜炎预防的指南。
