Antibiotics and suction drainage as prophylaxis in vaginal and abdominal hysterectomy.

A randomized prospective study compared the efficacy of a three-dose perioperative course of intravenously administered cefuroxime and metronidazole versus suction drainage of the vaginal vault for preventing postoperative infection in abdominal and vaginal hysterectomies. In vaginally operated patients, a significant difference in the rate of vaginal cuff abscess formation was found between the drain group and the antibiotic group (33 versus 0%). In the abdominally operated patients, no significant difference was found (7 versus 0%). The rate of cystitis was not influenced by the prophylactic method. A positive correlation was found between Bacteroides sp isolated from the vaginal fluid and vaginal cuff abscesses in the vaginally operated women. The complications of infection are explained by the decrease in host defense, occurring more frequently in patients treated with the vaginal approach than with the abdominal technique.