Download Antibiotic prophylaxis in vaginal mesh surgery

Antibiotic Prophylaxis in Pelvic Floor Repair (PFR) with Mesh
Authors: Dr Louisa Hermis, Dr Karen Guerrero, Dr Chris Hardwick
Institution : Southern General Hospital, Glasgow, Scotland.
Background:
Surgical-site infection is one of the most common post-operative complications resulting in a
longer hospital stay and more post-operative pain (1). There is little data on antibiotic
prophylaxis in Pelvic Floor Repairs (PFRs). Serious systemic infections, although rare, have
been reported with vaginal mesh insertion (2).
A literature search conducted over Medline, Pubmed and Cochrane Library identified NO
trials on the use of antibiotic prophylaxis in PFRs.
In our unit, prophylactic antibiotics are recommended in PFRs with mesh.
Aims:
1.
2.
3.
To discover what antibiotic prophylaxis regime each consultant used
To determine compliance with consultants’ specific regimes
To develop a unified protocol for the use of antibiotics in mesh repair.
Method:
A retrospective review involving women who underwent PFR with mesh at a tertiary
urogynaecology centre. Patients were identified from theatre records. Comparisons were
made between consultants’ choice of post-operative antibiotic prophylaxis regimes and the
antibiotics actually received by patients.
Results:
The data of 41 women between 42 and 82 years of age were reviewed. 20 women had
anterior PFR, 16 posterior PFR and 5 women had total vaginal mesh repair. None had intraoperative complications. None were treated for post-op surgical-site infection.
There were 6 different consultant antibiotic regimes.
All 41 women had intra-operative antibiotics (100% compliance).
The majority of women received post-operative antibiotics but this did not always comply with
their consultants’ choice of regime. The presence of different antibiotic prophylaxis regimes,
early discharge and lack of unified post-operative policy led to compliance to consultants’
specific antibiotic regimes being only 14.6%.
Conclusion:
There is a need for a unit protocol, which can then be easily followed by medical and nursing
staff. This then needs to be audited.
Ideally, we need randomised controlled trials to determine clinical effectiveness of
prophylactic antibiotics in vaginal surgery, including PFR with mesh.
References:
1.
Jarvis WR. Selected aspects of the socioeconomic impact of nosocomial infections: morbidity, mortality,
cost and prevention. Infect Control Hosp Epidemiol 1996;17:552-7.
2.
Abdel-Fattah M, Ramsay I; West of Scotland Study Group. Retrospective multicentre study of the new
minimally invasive mesh repair devices for pelvic organ prolapse. BJOG 2008;Jan;115(1):22-30.