Antibiotic prophylaxis versus empirical therapy in routine abdominal hysterectomy in tertiary care hospital

Adrita Deb; Shahanara Chowdhury; Nasreen Banu; Lipika Chowdhury

doi:10.18203/2320-6012.ijrms20263531

Authors

Adrita Deb Urban Primary Health Care Services Delivery Project, Mamata, PA-2, CCC, South Kattali, Halisohor, Chattogram, Bangladesh
Shahanara Chowdhury Department of Obstetrics and Gynaecology, Chittagong Medical College, Chattogram, Bangladesh
Nasreen Banu Department of Obstetrics and Gynaecology, Chittagong Medical College, Chattogram, Bangladesh
Lipika Chowdhury Hathazari Upazilla Health Complex, Hathazari, Chattogram, Bangladesh

DOI:

https://doi.org/10.18203/2320-6012.ijrms20263531

Keywords:

Tertiary care hospital, Surgical site infection, Postoperative morbidity, Empirical therapy, Abdominal hysterectomy, Antibiotic prophylaxis, Antimicrobial stewardship, Ceftriaxone

Abstract

Background: Surgical site infection remains an important cause of postoperative morbidity after abdominal hysterectomy. Although antibiotic prophylaxis is widely recommended, empirical postoperative antibiotic therapy is still commonly practiced in many tertiary care settings. This study aimed to compare the clinical outcomes of antibiotic prophylaxis and empirical therapy in routine abdominal hysterectomy.

Methods: This comparative study included 88 women undergoing routine abdominal hysterectomy in the Department of Obstetrics and Gynaecology, Chittagong Medical College Hospital. Participants were divided into two groups of 44 patients each. Group-A received antibiotic prophylaxis with intravenous ceftriaxone 1 g, administered 30 minutes before surgery. Group-B received the same preoperative dose followed by intravenous ceftriaxone 1 g 12-hourly for 72 hours and oral cefixime 400 mg twice daily for 7 days. Patients were followed for 30 days. Outcomes included superficial surgical site infection, postoperative complications, further antibiotic requirement, wound condition and duration of hospital stay.

Results: Superficial surgical site infection occurred in 5 patients (11.4%) in Group-A and 7 patients (15.9%) in Group-B, with no statistically significant difference (p=0.534). Postoperative complications were observed in 43.2% of Group-A and 36.4% of Group-B patients (p=0.513). Further antibiotic use was required equally in both groups, 8 patients (18.2%) each (p=1.000). Healthy wound condition during follow-up was observed in 88.6% and 86.4% of patients, respectively (p=0.747). Mean hospital stay was 6.75±4.27 days in Group-A and 8.18±6.42 days in Group-B (p=0.221).

Conclusions: Single-dose antibiotic prophylaxis showed comparable clinical outcomes to empirical postoperative therapy in routine abdominal hysterectomy and may support rational antibiotic use.

References

Berríos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, et al. Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg. 2017;152(8):784-91.

American College of Obstetricians and Gynecologists (ACOG). ACOG Practice Bulletin No. 195: Prevention of infection after gynecologic procedures. Obstet Gynecol. 2018;131(6):e172-89.

World Health Organization (WHO). Global guidelines for the prevention of surgical site infection. 2nd ed, 2018. Available at: https://www.who.int/publications/i/item/9789241550475. Accessed 01 July 2026.

Centers for Disease Control and Prevention (CDC). Surgical Site Infection Prevention Guideline, 2024. Available at: https://www.cdc.gov/infection-control/hcp/surgical-site-infection/index.html. Accessed 01 July 2026.

Petousis S, Angelou P, Almperis A, Laganà AS, Titilas G, Margioula-Siarkou C, et al. Prophylactic antibiotics before gynecologic surgery: a comprehensive review of guidelines. J Pers Med. 2024;14(3):327.

Cooper L, Sneddon J, Afriyie DK, Sefah IA, Kurdi A, Godman B, et al. Supporting global antimicrobial stewardship: antibiotic prophylaxis for the prevention of surgical site infection in low- and middle-income countries (LMICs): a scoping review and meta-analysis. JAC Antimicrob Resist. 2020;2(3):dlaa070.

Sharif MH, Karim MM, Shawon GM, Shammi SS. Pattern of surgical antibiotic prophylaxis in a tertiary care hospital of Bangladesh. East West Med Coll J. 2024;12(1):70-4.

Uppal S, Harris J, Al-Niaimi A, Swenson CW, Pearlman MD, Reynolds RK, et al. Prophylactic antibiotic choice and risk of surgical site infection after hysterectomy. Obstet Gynecol. 2016;127(2):321-9.

American College of Obstetricians and Gynecologists (ACOG). ACOG Committee Opinion No. 750: Perioperative pathways: Enhanced Recovery After Surgery. Obstet Gynecol. 2018;132(3):e120-30.

Ayeleke RO, Mourad S, Marjoribanks J, Calis KA, Jordan V. Antibiotic prophylaxis for elective hysterectomy. Cochrane Database Syst Rev. 2017;2017(6):CD004637.

Till SR, Morgan DM, Bazzi AA, Pearlman MD, Abdelsattar Z, Campbell DA, et al. Reducing surgical site infections after hysterectomy: metronidazole plus cefazolin compared with cephalosporin alone. Am J Obstet Gynecol. 2017;217(2):187.e1-11.

Pellegrini JE, Toledo P, Soper DE, Bradford WC, Cruz DA, Levy BS, et al. Consensus bundle on prevention of surgical site infections after major gynecologic surgery. Obstet Gynecol. 2017;129(1):50-61.

Ekanem EE, Oniya O, Saleh H, Konje JC. Surgical site infection in obstetrics and gynaecology: prevention and management. Obstet Gynaecol. 2021;23(2):124-37.

Ribero L, Santía MC, Borchardt K, Zabaneh F, Beck A, Sadhu A, et al. Surgical site infection prevention bundle in gynecology oncology surgery: a key element in the implementation of an enhanced recovery after surgery (ERAS) program. Int J Gynecol Cancer. 2024;34(9):1445-53.

Sefah IA, Chetty S, Yamoah P, Bangalee V. The impact of antimicrobial stewardship interventions on appropriate use of surgical antimicrobial prophylaxis in low- and middle-income countries: a systematic review. Syst Rev. 2024;13:306.

Directorate General of Health Services (DGHS). Ministry of Health and Family Welfare. National Strategy and Action Plan for Antimicrobial Resistance Containment in Bangladesh, 2023-2028, 2024. Available at: https://objectstorage.ap-dcc-gazipur-1.oraclecloud15.com/n/axvjbnqprylg/b/ V2Ministry/o/office-dghs/2024/12/84e68e82dde 3409b8372979e9de0ea40.pdf. Accessed 01 July 2026.