Staphylococcus aureus. Key words:

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Νικηφόρος Μανιάκης
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1 Staphylococcus aureus Key words: I

2 Table. Complicationsin,65laparoscopichysterectomies Bleeding 4(.%) Umbilicalcordincision Epigastricartery Iliacartery Intraabdominal,postoperative 5 Vaginalcufbleeding,postoperative 4 (.7%) Bladder Duringlaparoscopy 4 Vaginaly Ureter 5 Bowel 5(.4%) 65(5.6%) Trocarincision 7 Idiopathicfeverofunknownorigin 9 Vaginalcufhematomaandfever 5 Vaginalcufabscess Miscelaneous (.%) Thrombosis Nerveparesis Al 9(.%) II III IV

3 Table. Complicationsinlaparoscopy:openversusclosedentry Complication Closed-entry (n=,7) Open-entry (n= 579) P Vascular Abdominalwalbleeding Intraabdominalbleeding Gastrointestinallesion Failedaccess Bladderinjury 9(4) 7() () 9(5) (7) (7) (5) (5) (5) <. <. <. Total 8(9) 8() <. Table. morbidityinlaparoscopicalyassistedvaginalhysterectomy,abdominalhysterectomy,andvagi nalhysterectomy morbidity(%) Laparoscopicalyassisted vaginalhysterectomy (%) Abdominalhysterectomy (%) Vaginalhysterectomy (%) Idiopathicfever Pelviccelulitis Pelvichematoma/abscess infection Pneumonia Woundinfection Table4. duringhospitalization(number(%) Abdominalhysterectomy (N= 56) Vaginalhysterectomy (N= 5) Laparoscopichysterectomy (N= 66) Total (N= 687) Incisionalwound Vaginalcuf Miscelaneous Idiopathicfever Patientsinfected 56(.9) 4(4.7) 9(5.6) 7(.4) (.9) (.4) (.4) 7(6.7) ( ) (.) 4(8.) (.5) ( ) ( ) (.5) ( ) (.) 9(.) 4(.5) 6(5.) 8(.) (.6) 6(.7) V

4 Table5. Factorsassociatedwithposthysterectomyduringhospitalization, byinfection Factor.Age> 55years.BMI> 7.9.Chronicorunderlyingdisease 4.Lackofantibioticprophylaxis 5.Intermitentcatheterization 6.Urinarycatheter 7.Postoperativemedication 8.Latesutureremoval Incisionalwound Vaginalcuf Urinaryandincisionalwound Significanceisbyp<.,BMI= bodymassindex. Laxativesandcholinergicmedicationtofacilitatebladderemptying. Suturesremovedlaterthan5.7days(SD.8days)inabdominalhysterectomy inpatientswithpreviouslaparotomy. Table6. Factorsassociatedwithposthysterectomyinfectionduringhospitalization:univariateandmultivariateanalysis Factor Operative approach-abodominalversusvaginalandlaparoscopic Antibioticprophylaxis Bloodloss< ml Bloodloss-mL Bloodloss> ml Wounddrainage Intermitentcatheterization Anemia Postoperative medication-laxatives, cholinergicagents Univariate analysis Statistical significance (p) Infectedversus uninfected patients OR(95%CI).(.7to.6).4(.to.7)..(.to.).7(.to.7).4(.to.8).4(.7to.5).(.4to.8).(.9to4.8) Significanceisgivenbyp<..OR= oddsratio,ci= confidenceinterval. Multivariate analysis Statistical significance (p) Infectedversus uninfected patients OR(95%CI).(.7to.8).4(.to.6)..(.4to.6).6(.to.8).6(.to.).(.4to.).7(.5to4.7).6(.6to4.)

5 Table7. Complicationsbycategorizedgroupbysurgicalprocedure Complication Perioperativecomplication Haemorhagia Transfusion Bladderinjury Ureteralinjury Intestinalinjury Postoperativecomplication Hyperthermia Transfusion infection Abdominalwalabscess Abdominalwalhaematoma Pelvichematoma Urinaryretention Pulmonaryembolism Phlebitis Laparotomy (n= 94) 8(8.5) 5 (.4) 6 4 Vaginalsurgery (n= ) (.7) (.9) 8 Sometimesmorethanonepostoperativecomplicationforthesamepatient. Operative laparoscopy (n= ) (.) (6.5) Procedure Vaginal/abdominal hysterectomy * Laparoscopy Laparotomy Hysteroscopy Hysterosalpingogram IUDinsertion Endometrialbiopsy Inducedabortion/D&C Urodynamics Table8. Antimicrobialprophylacticregimen,byprocedure Antibiotic Cefazolin Cefoxitin Metronidazole ** Tinidazole ** Doxycycline *** Doxycycline Metronidazole Dose orgdoseiv gsingle-doseiv gsingle-doseiv gsingleoraldose4-hourspreoperatively mgoraly,twicedailyfor5days mgoralyhourbeforeprocedureand mgoralyafterprocedure 5mgoraly,twicedailyfor5days Abbreviations:IV,intravenously;IUD,intrauterinedevice;D&C,dilationandcuretage * Aconvenienttimetoadministerantibioticprophylaxisisjustbeforeinducedanesthesia. ** Antimicrobialagentsofchoiceinwomenwithahistoryofimmediatehypersensitivitytopenicilin. *** Ifhysterosalpingogram demonstratesdilatedfalopiantubes.noprophylaxisisindicatedforacase withoutdilatedtubes. VI Staphylococcus aureus

6 Table9. Broad-spectrum antibioticsfortreatingpostoperativepelvicinfection Class Cephamycins Cephalosporins Carbapenems Penicilins Combination Cefotetan Cefoxitin Ceftizoxime Imipenem Meropenem Antimicrobialagent Sulbactam/ampicilin Tazobactam/piperacilin Ticarcilin/clavulanate Clindamycin+ gentamicin± ampicilin Metronidazole+ gentamicin+ ampicilin β VII

7 Prevotella bivia Staphylococcus aureus

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