Appropriateness of antibiotic prophylaxis in gynecologic surgery at Srinagarind Hospital.

OBJECTIVE: To evaluate the rate of appropriate prophylactic antibiotic use in gynecologic surgery at Srinagarind Hospital. DESIGN STUDY: Prospective descriptive study. SETTING: Srinagarind Hospital, Khon Kaen University, Thailand. MATERIAL AND METHOD: Medical records of 250 women who had undergone gynecologic surgery at Srinagarind Hospital during August 2004 and February 2005 were evaluated. The criteria of appropriate prophylactic antibiotics were based on ACOG recommendation 2001. Data on demographic information, surgery procedure and antibiotic use during surgery were extracted from these medical records and analyzed. MAIN OUTCOMES: Rate of appropriate prophylactic antibiotic use and type of inappropriate use. RESULTS: Two hundred and fifty women had undergone gynecologic surgery during the study period. There were 168 total abdominal hysterectomy (TAH), 12 vaginal hysterectomy (VH), 30 salpingooophorectomy (SO), 3 myomectomy, 30 diagnostic laparoscopy and 7 laparoscopic ovarian cystectomy (LOC). Twenty private staff and twenty residents conducted these operations. The overall rate of appropriate prophylactic antibiotic use was 75.2% (95% CI 69.28-80.33). Main type of inappropriate use were multiple doses and indication not fulfilled. The overall rate of appropriate antibiotic prophylaxis among surgeries conducted by private staff was 53.19% (95% CI 42.66-63.46) and the overall rate of appropriate antibiotic prophylaxis among surgeries conducted by residents was 88.46% (95% CI 82.13-93.83). The rate of early post operative infection between both groups was not different (p = 0.529). There was no drug complication in all subjects. CONCLUSION: The overall rate of appropriate antibiotic prophylaxis in gynecologic surgery at Srinagarind Hospital was 75.2% (95% CI 69.28-80.33). Residents used prophylactic antibiotics more appropriately than private staff.

Effectiveness of vaginal douching on febrile and infectious morbidities after total abdominal hysterectomy: a multicenter randomized controlled trial.

OBJECTIVE: To evaluate the effectiveness of vaginal douching with 1 per cent povidone-iodine in reducing febrile and infectious morbidities after total abdominal hysterectomy (TAH). METHOD: The authors conducted a randomized controlled trial in 300 patients undergoing elective TAH in three hospitals in Northeast Thailand: a university, a regional and a general hospital. The patients were randomly allocated to the intervention or control groups. Patients in the intervention group received pre-operative vaginal douching with 1 per cent povidone-iodine while patients in the control group did not. External evaluators not apprised of the intervention assessed febrile and infectious morbidities. RESULTS: 300 patients were enrolled in the study. The incidences of febrile morbidity in patients with and without pre-operative vaginal douching were 25 and 35 per cent, respectively, though not statistically significant (risk difference -9.6%, 95% CI -19.9%, 0.8%, adjusted odds ratio 0.6, 95% CI 0.3%, 1.0%). A statistically significant difference in infectious morbidity was found between the groups (8 vs 19%, risk difference -10.0%, 95% CI -17.8%, -2.2%, adjusted odds ratio 0.4, 95% CI 0.2%, 0.9%). CONCLUSION: Pre-operative vaginal douching with 1 per cent povidone-iodine significantly reduces infectious morbidities after TAH.

Reagent strip testing is not sensitive for the screening of asymptomatic bacteriuria in pregnant women.

The objective of the study was to assess the diagnostic performance of the reagent strip in screening for asymptomatic bacteriuria in pregnant women using urine culture as a gold standard. This study comprised 204 asymptomatic pregnant women who attended their first antenatal care at Srinagarind Hospital, Khon Kaen University from April 1, 1999 to June 30, 1999. Women with symptoms of urinary tract infection, antibiotic treatment within the previous 7 days, pregnancy-induced hypertension, bleeding per vagina and history of urinary tract diseases were excluded. Urine specimens were collected by clean catched midstream urine technique for urinalysis, reagent strip test and urine culture. Diagnostic performance of reagent strip in terms of sensitivity, specificity, positive and negative predictive value was analyzed. Urine reagent strip test had a sensitivity of 13.9 per cent, a specificity of 95.6 per cent, a positive predictive value of 46.1 per cent, a negative predictive value of 80.6 per cent in detecting asymptomatic bacteriuria in pregnant women.