Per-Göran Larsson1, Bodil Carlsson. 1. Department of Obstetrics and Gynecology, Kärnsjukhuset, S-541 85 Skövde, Sweden. p-g.larsson@vgregion.se
Abstract
OBJECTIVE: Bacterial vaginosis (BV) is a known risk factor for postoperative infection following abdominal hysterectomy. Vaginal bacterial flora scored as intermediate has been shown to have the same risk of postoperative infection as BV. METHODS:Women undergoing total abdominal hysterectomy for benign diseases were open-randomized according to Zelen to either treatment with metronidazole rectally for at least 4 days or no treatment. At the preoperative gynecological examination a vaginal smear was collected and Gram stained. Women with BV or intermediate flora were merged to one group called abnormal vaginal flora. RESULTS:In total 213 women were randomized to treatment or no treatment. After exclusion of 71 women, 142 women were eligible for analysis. Among the 59 women diagnosed with abnormal vaginal flora there were no vaginal cuff infections in the treated arm, compared with 27% in the 'no treatment' arm (p < 0.01). Treatment also reduced the vaginal cuff infection rate from 9.5 to 2% among the 83 women with lactobacilli flora. However, this difference was not statistically significant. Treatment had no effect on the rate of wound infections. Intention-to-treat analysis showed a significant reduction in vaginal cuff infections among women randomized to treatment. CONCLUSION: Pre- and postoperative treatment for at least 4 days with metronidazole rectally reduces significantly vaginal cuff infection among women with abnormal vaginal flora.
RCT Entities:
OBJECTIVE:Bacterial vaginosis (BV) is a known risk factor for postoperative infection following abdominal hysterectomy. Vaginal bacterial flora scored as intermediate has been shown to have the same risk of postoperative infection as BV. METHODS:Women undergoing total abdominal hysterectomy for benign diseases were open-randomized according to Zelen to either treatment with metronidazole rectally for at least 4 days or no treatment. At the preoperative gynecological examination a vaginal smear was collected and Gram stained. Women with BV or intermediate flora were merged to one group called abnormal vaginal flora. RESULTS: In total 213 women were randomized to treatment or no treatment. After exclusion of 71 women, 142 women were eligible for analysis. Among the 59 women diagnosed with abnormal vaginal flora there were no vaginal cuff infections in the treated arm, compared with 27% in the 'no treatment' arm (p < 0.01). Treatment also reduced the vaginal cuff infection rate from 9.5 to 2% among the 83 women with lactobacilli flora. However, this difference was not statistically significant. Treatment had no effect on the rate of wound infections. Intention-to-treat analysis showed a significant reduction in vaginal cuff infections among women randomized to treatment. CONCLUSION: Pre- and postoperative treatment for at least 4 days with metronidazole rectally reduces significantly vaginal cuff infection among women with abnormal vaginal flora.
Authors: P G Larsson; J J Platz-Christensen; K Dalaker; K Eriksson; L Fåhraeus; K Irminger; F Jerve; B Stray-Pedersen; P Wölner-Hanssen Journal: Acta Obstet Gynecol Scand Date: 2000-05 Impact factor: 3.636
Authors: Uri P Dior; Shamitha Kathurusinghe; Claudia Cheng; Charlotte Reddington; Andrew J Daley; Catarina Ang; Martin Healey Journal: JAMA Surg Date: 2020-09-01 Impact factor: 14.766
Authors: Michelle Kuznicki; Adrianne Mallen; Emily Clair McClung; Sharon E Robertson; Sarah Todd; David Boulware; Stacy Martin; Rod Quilitz; Roberto J Vargas; Sachin M Apte Journal: Int J Gynecol Cancer Date: 2020-07-29 Impact factor: 3.437