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Cefazolin as surgical antimicrobial prophylaxis in hysterectomy: A systematic review and meta-analysis of randomized controlled trials

Published online by Cambridge University Press:  05 December 2018

Aurora Pop-Vicas ,
Stephen Johnson  and
Nasia Safdar
Aurora Pop-Vicas*
Affiliation:
Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Stephen Johnson
Affiliation:
Ebling Library for the Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Nasia Safdar
Affiliation:
Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin William S. Middleton Memorial Veterans Affairs Hospital, Madison, Wisconsin
*
Author for correspondence: Aurora Pop-Vicas, MD, MPH, Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave, 5th floor, Madison, WI 53705. E-mail: popvicas@medicine.wisc.edu
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Abstract

Objective

Current practice guidelines recommend cefazolin, cefoxitin, cefotetan, or ampicillin-sulbactam as first-line antibiotic prophylaxis in hysterectomy. We undertook this systematic review and meta-analysis of randomized controlled trials (RCTs) to determine whether cefazolin, with limited antianaerobic spectrum, is as effective in preventing surgical site-infection (SSI) as the other first-choice antimicrobials that have more extensive antianaerobic activity.

Methods

We searched PubMed, Scopus, Web of Science, Cochrane Central, and EMBASE for relevant randomized controlled trials (RCT) in any language up to January 23, 2018. We only included trials that measured SSI (our primary outcome) defined as superficial, deep, or organ space. We excluded trials of β-lactams no longer in clinical use.

Results

In terms of SSI incidence, cefazolin use was not inferior to its comparator in 12 of 13 individual RCTs included in the analysis. The meta-analysis summary estimate showed a significantly higher SSI risk with cefazolin versus cefoxitin or cefotetan (risk ratio, 1.7; 95% CI, 1.04–2.77; P = .03). However, most studies included nonstandardized dosing and duration of antimicrobial prophylaxis, had indeterminate or high risk of bias, did not include patients with gynecological malignancies, and/or were older RCTs not reflective of current clinical practices.

Conclusion

Due to inherent limitations associated with old RCTs with limited relevance to contemporary surgery, an RCT of cefazolin versus regimens with significant antianaerobic spectrum is needed to establish the optimal choice for SSI prevention in hysterectomy.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 2 , February 2019 , pp. 142 - 149
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

Cite this article: Pop-Vicas A, et al. (2019). Cefazolin as surgical antimicrobial prophylaxis in hysterectomy: A systematic review and meta-analysis of randomized controlled trials. Infection Control & Hospital Epidemiology 2019, 40, 142–149. doi: 10.1017/ice.2018.286

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