Periti P, Mazzei T, Periti E
Dipartimento di Farmacologia Preclinica e Clinica, University of Florence, Italy.
Chemioterapia. 1988 Aug;7(4):245-52.
Antimicrobial prophylaxis is recommended in all clean-contaminated surgery where the critical threshold of number and virulence of the contaminating organisms with respect to host resistance is reached. Obstetric and gynaecological surgery is clean-contaminated and risk of infection due to aerobic and anaerobic bacteria without prophylaxis can be quantified at 30-40% for vaginal hysterectomy, 10-35% for abdominal hysterectomy and 10-34% for caesarean section. To assess the role of two different cephalosporins as short term prophylaxis, we carried out a multicentre randomised study involving a single 2 g i.v. dose of cefotetan in comparison with two doses of cefazolin (2 g i.v. before surgery and after 8 hours). Criteria for exclusion were: exposure to antibiotics within 7 days, preoperative infection, hypersensitivity to beta-lactams. Four hundred and sixty patients entered the study, of which 229 received cefotetan and 231 cefazolin. No significant differences in mean age, obesity, preoperative weight loss, diabetes, type of disease, type of surgery (vaginal or abdominal hysterectomies and caesarean sections) and number of pregnancies and abortions existed between the two groups of patients. The total rate of infected patients undergoing hysterectomy was 8.6% (13/151) in the cefotetan group and 17.4% (29/167) in the cefazolin group (p less than 0.05). This difference was due to cases of symptomatic bacteriuria and antibiotic retreatment, while wound infections were not significantly different (2.6% and 1.8% respectively). Among patients undergoing caesarean section, 9 of 78 (11.5%) and 7 of 64 (10.9%) were infected following cefotetan and cefazolin, respectively (not significant). Cefotetan mean tissue concentrations in gynaecological organs were higher than those of cefazolin (25.5-44.8 vs. 7.4-9.5 mg/kg).(ABSTRACT TRUNCATED AT 250 WORDS)
对于所有清洁-污染手术，若污染菌数量及毒力相对于宿主抵抗力达到临界阈值，则推荐进行抗菌药物预防。妇产科手术属于清洁-污染手术，若无预防措施，因需氧菌和厌氧菌导致的感染风险在阴道子宫切除术中可量化为30%-40%，腹部子宫切除术中为10%-35%，剖宫产术中为10%-34%。为评估两种不同头孢菌素作为短期预防用药的作用，我们开展了一项多中心随机研究，涉及单次静脉注射2克头孢替坦，并与两剂头孢唑林（术前及术后8小时各静脉注射2克）进行比较。排除标准为：7天内使用过抗生素、术前感染、对β-内酰胺类药物过敏。460例患者进入研究，其中229例接受头孢替坦治疗，231例接受头孢唑林治疗。两组患者在平均年龄、肥胖程度、术前体重减轻情况、糖尿病、疾病类型、手术类型（阴道或腹部子宫切除术及剖宫产术）以及妊娠和流产次数方面均无显著差异。接受子宫切除术的感染患者总发生率在头孢替坦组为8.6%（13/151），在头孢唑林组为17.4%（29/167）（p<0.05）。这种差异是由于有症状性菌尿症病例和抗生素再治疗，而伤口感染无显著差异（分别为2.6%和1.8%）。在接受剖宫产的患者中，头孢替坦组78例中有9例（11.5%）感染，头孢唑林组64例中有7例（10.9%）感染（无显著差异）。头孢替坦在妇科器官中的平均组织浓度高于头孢唑林（25.
