Surgical site infection in obstetrics & gynaecology

M R C O G PA R T 2 · S O S P O C K E T C A R D · K N O W L E D G E A R E A 4 – P O S T O P E R AT I V E C A R E

Surgical Site Infection in Obstetrics & Gynaecology Ekanem E et al. Surgical site infection in obstetrics and gynaecology: prevention and management. TOG 2021;23:124–137. doi:10.1111/tog.12730

2–6% 60–70% £959–1300 SSI INCIDENCE, HIGH-INCOME COUNTRIES SSI/ENDOMETRITIS REDUCTION WITH EXTRA COST PER SSI (UK) PROPHYLACTIC ANTIBIOTICS

DO N' T-M IS S FA C TS

  1. SSI onset: superficial/deep ≤30 days (no implant) or ≤1 year (implant) after surgery

  2. Antibiotics: single IV dose within 60 min before skin incision – reduces SSI/endometritis/serious infection by 60–70%

  3. Co-amoxiclav before CS → ↑ neonatal necrotising enterocolitis – give after cord clamping

  4. Redose if surgery >3h or blood loss >1500 ml; cefazolin 3 g if >120 kg (standard 2 g)

  5. Skin prep: alcohol-chlorhexidine first-line (NICE); dry for 3 minutes before incision

  6. No prophylaxis needed for clean uncomplicated surgery (diagnostic laparoscopy, simple cystectomy, sterilisation)

  7. NICE: sutures not staples for CS skin closure; SC closure only helps if fat >2 cm

  8. Fever >38°C ×2, ≥4h apart, >24h post-op → evaluate for SSI (typical onset 4–7 days)

SSI RATES BY PROCEDURE

Vaginal hysterectomy (Sweden) 11.6%

Abdominal hysterectomy (Sweden) 3.79%

LSCS (Sweden) 3.76%

Abdominal hysterectomy (England NHS audit) 1.6%

CS – worldwide reported range, upper end 15.0%

Selected rates reported across studies in the review

ABBREVIATION KEY

SSI — surgical site infection MSSA — methicillin-sensitive Staphylococcus aureus

CDC — Centers for Disease Control CoNS — coagulase-negative staphylococci

NICE — National Institute for Health and Care Excellence RCT — randomised controlled trial

ACOG — American College of Obstetricians and Gynecologists RR — relative risk

WHO — World Health Organization OR — odds ratio

ACS — American College of Surgeons CI — confidence interval

SIS — Surgical Infection Society IV — intravenous

MRSA — methicillin-resistant Staphylococcus aureus MIC — minimum inhibitory concentration CS — caesarean section ASA — American Society of Anaesthesiology

NPWT — negative pressure wound therapy NHS — National Health Service

ERAS — enhanced recovery after surgery FDA — Food and Drug Administration

CRP — C-reactive protein SC — subcutaneous

Source: The Obstetrician & Gynaecologist (TOG), RCOG journal — doi:10.1111/tog.12730

Clinically reviewed by NHS obstetricians and gynaecologists

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