Infectious Diseases in Obstetrics and Gynecology 5:52-56 (1997) (C) 1997 Wiley-Liss, Inc. Infection After Hysterectomy David L. Hemsell* Department of Obstetrics and Gynecology, University of Texas Southavestern Medical Center, Parkland Memorial Hospital, Dallas, TX ABSTRACT Antibiotic prophylaxis and advances in technology have reduced operative site infections after hysterectomy to a minimum. Pelvic infections are the most common infection type and respond promptly to a variety of parenteral single-agent and combination antibiotic regimens. Oral antibiotic regimens following parenteral therapy are unnecessary. Abdominal incision infections are less common than pelvic infections, less common than seromas or hematomas, and usually do not require antimicrobial therapy. Abscesses or infected hematomas require parenteral antimicrobial therapy, and drainage of those located above the cuff will predictably shorten therapy time. With early discharge from the hospital, many infections will not become evident until after the patient is home. For that reason, it is important that the patient’s discharge instructions outline symptoms and signs associated with these infections so she can present for care at the earliest possible time. Infect. Dis. Obstet. Gynecol. 5:52-56, 1997. (C) 1997 Wiley-Liss, Inc. KEY WORDS female pelvic surgery; antibiotics; hysterectomy he late 1940s and early 1950s brought signifi- cant advances to the field of elective pelvic from 5 to 70%, but most reports were mid-range, and higher after vaginal hysterectomy. It was dif- surgery. Surgical skill refinement, adherence to ficult to identify uniform risk factors for postopera- sterile technique, improved suture material, and tive infection other than lower socioeconomic sta- reduction in lower reproductive tract bacterial in- oculum were important advances, but not as im- portant as the introduction of antibiotics. Richards reported in 1944 that the local application of sul- fonamide at the time of hysterectomy did not alter infection rates or cause adverse events. Turnerz reported 6 years later that penicillin vaginal sup- positories significantly reduced infectious morbid- ity following vaginal hysterectomy. Antimicrobial prophylaxis currently is used by most gynecologists performing hysterectomy, irrespective of route. If tus, immunocompromised host, and infection or flora overgrowth. A good example of the last vari- able is the recently reported3,4 association between preoperative bacterial vaginosis and an increase in the rate of operative site infection following hys- terectomy. Bacteria that have been reported in flora and infection studies and that are potential pathogens recovered from operative site infections after hys- terectomy are presented in Table 1. Bacterial in- oculum and virulence factors are complex, expen- infection rates are low without prophylaxis, how- sive to elucidate, and difficult to evaluate in the ever, antimicrobial prophylaxis is not indicated. Without prophylaxis, the reported incidence of operative site infection after hysterectomy ranged clinical setting. As difficult to identify are cell- mediated and humoral immune system function in each patient. It is ultimately the interaction be- *Correspondence to: Dr. David L. Hemsell, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, G6.226, Dallas, TX 75235-9032. Review Article Received 2 December 1996 Accepted 14 January 1997