Does Pre- and Postoperative Metronidazole Treatment LowerVaginal Cuff Infection Rate After Abdominal HysterectomyAmong Women With Bacterial Vaginosis?

[摘要] 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 postoperativeinfection as BV.Methods:Women undergoing total abdominal hysterectomy for benign diseases were open-randomized accordingto Zelen to either treatmentwith metronidazole rectally for at least 4 days or no treatment. At the preoperativegynecological examination a vaginal smear was collected and Gram stained. Women with BV or intermediate florawere 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, 142women were eligible for analysis. Among the 59 women diagnosed with abnormal vaginal flora there were novaginal cuff infections in the treated arm, comparedwith 27% in the ‘no treatment’ arm (p<0.01). Treatment alsoreduced 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 randomizedto treatment.Conclusion:Pre- and postoperative treatment for at least 4 days with metronidazole rectally reducessignificantly vaginal cuff infection among women with abnormal vaginal flora.

[学科分类] 妇产科学