Pelvic Surgical Site Infections in Gynecologic Surgery

Table 1

Antimicrobial prophylaxis in gynecologic surgery.

Type of procedure	Recommended agents	Alternative agents in pts with -lactam allergy
Hysterectomy	Cefazolin, cefotetan, cefoxitin, or ampicillin-sulbactam^[a]	Clindamycin or vancomycin + aminoglycoside^[b]; or aztreonam alone; or fluoroquinolone alone^[a,c]; or metronidazole + aminoglycoside or fluoroquinolone
Laparoscopic procedure, low-risk	None	None
Laparoscopic procedure, high-risk^[d]	Cefazolin, cefoxitin, cefotetan, ampicillin-sulbactam^[a]	Clindamycin or vancomycin + aminoglycoside^[b]; or aztreonam alone; or fluoroquinolone alone^[a,c]; or metronidazole + aminoglycoside or fluoroquinolone
Clean-contaminated cancer surgery	Cefazolin + metronidazole, cefuroxime + metronidazole, ampicillin-sulbactam^[a]	Clindamycin

Adapted from  [25].
^[a]Due to increasing resistance of Escherichia coli to fluoroquinolones and ampicillin-sulbactam, local population susceptibility profiles should be reviewed prior to use.
^[b]Gentamicin.
^[c]Ciprofloxacin or levofloxacin; fluoroquinolones are associated with an increased risk of tendonitis and tendon rupture in all ages. However, this risk would be expected to be quite small with single-dose antibiotic prophylaxis. Although the use of fluoroquinolones may be necessary for surgical antibiotic prophylaxis in some children, they are not drugs of first choice in the pediatric population due to an increased incidence of adverse events as compared with controls in some clinical trials.
^[d]Factors that indicate a high risk of infectious complications include emergency procedures, diabetes, long procedure duration, age of >70 years, American Society of Anesthesiologists classification of 3 or greater, pregnancy, immunosuppression, and insertion of prosthetic device.