Antimicrobial prophylaxis to prevent mixed bacterial infection

Abstract

Mixed aerobic-anaerobic bacterial infections frequently complicate certain pelvic and abdominal surgical procedures. Four specific frequent operations which are accompanied by a notable risk of infection are vaginal hysterectomy, abdominal hysterectomy, primary Caesarean section, and colorectal procedures. In the past two decades, numerous randomized clinical trials have evaluated the efficacy of antimicrobial prophylaxis to prevent infectious complications following these procedures. A variety of antimicrobials and routes of administration have been evaluated. Despite the impressive quantity of data which has accumulated, controversies persist regarding the appropriate use of prophylaxis for these operations. Approximately 60 evaluable randomized clinical trials of prophylactic antimicrobials in patients undergoing one of these four surgical procedures have been reviewed. A statistical synthesis and summary of these trials is presented, along with recommendations for further, more focused research.