Women who receive ??-lactam prophylactic antibiotics have lower rates of infection than those receiving alternative regimens.

Prophylactic antibiotic choice greatly impacts the risk of surgical site infections in women undergoing hysterectomies, according to new research.

In a study published in Obstetrics and Gynecology, researchers found that women receiving various combinations of antibiotics had varied rates of post-op infections following hysterectomies. The study looked at those receiving ??-lactam antibiotics, those receiving alternatives to ??-lactam antibiotics and those using non-standard regimens.

For the study, researchers analyzed women in the Michigan Surgical Quality Collaborative who underwent a hysterectomy from July 2012 to February 2015. They grouped the women into 2 categories: those receiving prophylactic antibiotic regimens recommended by the American College of Obstetricians and Gynecologists and the Surgical Care Improvement Project, and those receiving non-recommended regimens.

The 2 groups were then divided further, with the recommended regimen group being split between patients receiving ??-lactam antibiotics (cephalosporins, ampicillin—sulbactam, ertapenem) and those receiving alternatives to ??-lactam antibiotics (clindamycin plus gentamicin, quinolone, aztreonam). The non-recommended regimen group was divided as women receiving overtreatment, who were excluded from final analysis, and those receiving non-standard antibiotics, like standalone clindamycin or standalone gentamicin.

The researchers found that while the overall rate of surgical site infections was 2.06%, the ??-lactam group had an SSI rate of 1.8%, while the ??-lactam alternative group's rate was 3.1%. Women receiving non-standard regimens had the highest SSI rate at 3.7%.

One possible explanation the researchers give for the differences is that ??-lactam antibiotics are known to be highly effective against skin flora, which often are responsible for SSIs. They also note that general concerns over patient allergies to penicillin — which many ??-lactam antibiotics are derivative of — could have providers overprescribing less-effective alternatives.

The authors conclude: "Efforts to decrease surgical site infections could focus on adherence to recommended preoperative antibiotic guidelines and thorough evaluation of patient-reported penicillin allergies to increase the number of patients receiving ??-lactam antibiotics."

Kendal Gapinski