Persson E, Bergström M, Larsson P G, Moberg P, Platz-Christensen J J, Schedvins K, Wølner-Hanssen P
Department of Obstetrics, University Hospital of Lund, Sweden.
Acta Obstet Gynecol Scand. 1996 Sep;75(8):757-61. doi: 10.3109/00016349609065742.
An increased use of prophylactic antibiotics to avoid postoperative infections in women undergoing hysterectomy has been observed in Sweden. This investigation was performed a) to study the infection rate to enable future evaluation of the effect of prophylactic antibiotic regimens and b) to identify subgroups suitable for intervention.
A prospective study comprising all women undergoing pelvic surgery with hysterectomy during a two month period at forty-two Departments of Obstetrics and Gynecology in Sweden. Relevant information regarding the surgical procedure and the postoperative course was included in a standardized form at discharge from hospital and at a follow-up visit 4 to 6 weeks after surgery.
Of the 1060 women included in the study, 23% developed postoperative infections: 9.4% had wound-, cuff-, and/or deep infections, 13% urinary tract infections, and 4% other infections unrelated to the surgical site. Only half of the wound/cuff-/deep infections were diagnosed before discharge from the hospital. Wertheim-Meigs procedures, bleedings per-operatively exceeding 1000 ml, and presence of bacterial vaginosis (BV) were associated with an increased risk of postoperative infections. Among women undergoing abdominal hysterectomy for benign reasons, (n = 159), wound-cuff/deep infection was significantly associated with preoperative BV, i.e. 7 of 28 (25%) vs. 11 of 131 (8%), respectively (relative risk = 3.0, p = 0.01). Infection was associated with prolonged postoperative hospital stay. Antibiotics were given pre- or postoperatively to 236 (22%) of the 1060 women. Reduction in the postoperative infection rate was seen among women undergoing vaginal hysterectomy who were given pre- or postoperative antibiotics.
The postoperative infection rate after hysterectomy was clinically significant in this population. Wertheim-Meigs procedures, peroperative bleeding > 1000 ml and BV were identified as risk factors for postoperative infections after hysterectomy.
在瑞典，已观察到接受子宫切除术的女性预防性使用抗生素以避免术后感染的情况有所增加。进行这项调查的目的是：a）研究感染率，以便未来评估预防性抗生素治疗方案的效果；b）确定适合进行干预的亚组。
一项前瞻性研究，纳入了瑞典42个妇产科在两个月内接受盆腔手术并进行子宫切除术的所有女性。有关手术过程和术后病程的相关信息在出院时以及术后4至6周的随访时以标准化表格形式记录。
在纳入研究的1060名女性中，23%发生了术后感染：9.4%有伤口、残端和/或深部感染，13%有尿路感染，4%有与手术部位无关的其他感染。只有一半的伤口/残端/深部感染在出院前被诊断出来。韦特海姆 - 迈格斯手术、术中出血超过1000毫升以及细菌性阴道病（BV）的存在与术后感染风险增加相关。在因良性原因接受腹部子宫切除术的女性（n = 159）中，伤口 - 残端/深部感染与术前BV显著相关，即分别为28例中的7例（25%）和131例中的11例（8%）（相对风险 = 3.0，p = 0.01）。感染与术后住院时间延长相关。1060名女性中有236名（22%）在术前或术后接受了抗生素治疗。在接受阴道子宫切除术且术前或术后接受抗生素治疗的女性中，术后感染率有所降低。
在该人群中，子宫切除术后的感染率具有临床意义。韦特海姆 - 迈格斯手术、术中出血> 1000毫升和BV被确定为子宫切除术后感染的危险因素。
