Addition of Metronidazole to Cefazolin for Surgical Site Injection Prophylaxis in Hysterectomy: A Systematic Review and Meta-Analysis

IF 3.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology Pub Date : 2025-10-22 DOI:10.1016/j.jmig.2025.09.024

MM Jackson , L Eckhardt , M Zamani , P Levett , S Endicott

{"title":"Addition of Metronidazole to Cefazolin for Surgical Site Injection Prophylaxis in Hysterectomy: A Systematic Review and Meta-Analysis","authors":"MM Jackson , L Eckhardt , M Zamani , P Levett , S Endicott","doi":"10.1016/j.jmig.2025.09.024","DOIUrl":null,"url":null,"abstract":"<div><h3>Study Objective</h3><div>Through systematic review and meta-analysis, evaluate whether adding metronidazole to cefazolin for hysterectomy is more effective in prevention of surgical site infection than the existing recommendation of cefazolin alone.</div></div><div><h3>Design</h3><div>Systematic review and meta-analysis.</div></div><div><h3>Setting</h3><div>N/A.</div></div><div><h3>Patients or Participants</h3><div>Systematic review of MEDLINE, ClinicalTrials.gov, EMBASE, Cochrane Library, and Web of Science were searched until October 16, 2024 that included the words: hysterectomy, cefazolin, metronidazole, and surgical site infection.</div></div><div><h3>Interventions</h3><div>Studies were included if they 1) consisted of peer-reviewed research published between 1995 and 2024, 2) assessed patients undergoing hysterectomy by any route, 3) compared cefazolin to cefazolin and metronidazole, and 4) reported primary outcome of surgical site infection within 30 days of procedure.</div></div><div><h3>Measurements and Primary Results</h3><div>Five studies with a total of 19,422 participants met eligibility criteria; two were randomized controlled trials and three were retrospective cohort studies. Three studies used intravenous metronidazole while two studies used vaginal metronidazole. The fixed effect meta-analysis from all five studies revealed an overall odds ratio of 0.49 [95% CI: 0.34-0.72] indicating an reduction of 51% in the odds of surgical site infection in those given metronidazole in addition to cefazolin versus cefazolin alone. When stratified by route of administration, the additional use of pre-operative intravenous metronidazole revealed an odds ratio of 0.52 [95% CI: 0.34-0.79] indicating an overall reduction of 48% in the odds of surgical site infection compared to cefazolin alone.</div></div><div><h3>Conclusion</h3><div>Systematic review and meta-analysis of the literature demonstrates that the use of metronidazole in addition to cefazolin reduces the risk of surgical site infection after hysterectomy by any route. Intravenous use of metronidazole in particular is cost-effective and may be the preferred route of administration by both the patient and surgeon.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S15"},"PeriodicalIF":3.3000,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of minimally invasive gynecology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1553465025003619","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Study Objective

Through systematic review and meta-analysis, evaluate whether adding metronidazole to cefazolin for hysterectomy is more effective in prevention of surgical site infection than the existing recommendation of cefazolin alone.

Design

Systematic review and meta-analysis.

Setting

N/A.

Patients or Participants

Systematic review of MEDLINE, ClinicalTrials.gov, EMBASE, Cochrane Library, and Web of Science were searched until October 16, 2024 that included the words: hysterectomy, cefazolin, metronidazole, and surgical site infection.

Interventions

Studies were included if they 1) consisted of peer-reviewed research published between 1995 and 2024, 2) assessed patients undergoing hysterectomy by any route, 3) compared cefazolin to cefazolin and metronidazole, and 4) reported primary outcome of surgical site infection within 30 days of procedure.

Measurements and Primary Results

Five studies with a total of 19,422 participants met eligibility criteria; two were randomized controlled trials and three were retrospective cohort studies. Three studies used intravenous metronidazole while two studies used vaginal metronidazole. The fixed effect meta-analysis from all five studies revealed an overall odds ratio of 0.49 [95% CI: 0.34-0.72] indicating an reduction of 51% in the odds of surgical site infection in those given metronidazole in addition to cefazolin versus cefazolin alone. When stratified by route of administration, the additional use of pre-operative intravenous metronidazole revealed an odds ratio of 0.52 [95% CI: 0.34-0.79] indicating an overall reduction of 48% in the odds of surgical site infection compared to cefazolin alone.

Conclusion

Systematic review and meta-analysis of the literature demonstrates that the use of metronidazole in addition to cefazolin reduces the risk of surgical site infection after hysterectomy by any route. Intravenous use of metronidazole in particular is cost-effective and may be the preferred route of administration by both the patient and surgeon.

查看原文本刊更多论文

甲硝唑加头孢唑林用于子宫切除术手术部位注射预防：一项系统回顾和荟萃分析

研究目的通过系统回顾和荟萃分析，评价头孢唑林联合甲硝唑行子宫切除术是否比现有推荐的头孢唑林单用更能有效预防手术部位感染。设计：系统评价和荟萃分析。患者或参与者：系统检索MEDLINE、ClinicalTrials.gov、EMBASE、Cochrane Library和Web of Science，检索截止到2024年10月16日，检索词包括：子宫切除术、头孢唑林、甲硝唑和手术部位感染。干预研究包括：1)由1995年至2024年间发表的同行评审研究组成，2)评估通过任何途径进行子宫切除术的患者，3)比较头孢唑林与头孢唑林和甲硝唑，4)报告手术后30天内手术部位感染的主要结局。5项研究共19,422名受试者符合入选标准；2项为随机对照试验，3项为回顾性队列研究。三项研究使用静脉注射甲硝唑，两项研究使用阴道注射甲硝唑。所有五项研究的固定效应荟萃分析显示，总体优势比为0.49 [95% CI: 0.34-0.72]，表明甲硝唑加头孢唑林与单独头孢唑林相比，手术部位感染的几率降低了51%。当按给药途径分层时，术前静脉注射甲硝唑的优势比为0.52 [95% CI: 0.34-0.79]，表明与单独使用头孢唑林相比，手术部位感染的几率总体降低了48%。结论系统回顾和文献荟萃分析表明，甲硝唑加头孢唑林可降低子宫切除术后手术部位感染的风险。静脉注射甲硝唑尤其具有成本效益，可能是患者和外科医生的首选给药途径。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of minimally invasive gynecology 医学-妇产科学

CiteScore

5.00

自引率

7.30%

发文量

272

审稿时长

37 days

期刊介绍： The Journal of Minimally Invasive Gynecology, formerly titled The Journal of the American Association of Gynecologic Laparoscopists, is an international clinical forum for the exchange and dissemination of ideas, findings and techniques relevant to gynecologic endoscopy and other minimally invasive procedures. The Journal, which presents research, clinical opinions and case reports from the brightest minds in gynecologic surgery, is an authoritative source informing practicing physicians of the latest, cutting-edge developments occurring in this emerging field.