**3.3 Antibiotic prophylaxis**

The degree of contamination at the time of surgery is classified using the National Healthcare Safety Network (NHSN) wound class. Hysterectomy is a cleancontaminated procedure and as a result, is unavoidably associated with a relatively higher risk of infection as the procedure breaches the genital tract. Common sites of infection after hysterectomy include the abdominal wall, the vaginal cuff, bladder, and pelvic floor. Related complications include pelvic abscess or infected

#### *Surgical Site Infection after Hysterectomy DOI: http://dx.doi.org/10.5772/intechopen.101492*

hematoma and sepsis. A patient's individual susceptibility to infection depends on a variety of factors including bacterial virulence, extent of surgery-related tissue trauma and fluid collection, the effectiveness of the patient's immune system, age, nutritional status, presence of diabetes, smoking, coexistent infection or colonization with microorganisms. Perhaps the most important factors in SSI prevention in hysterectomy are timely administration of appropriate preoperative antibiotics and meticulous surgical technique. Use of β-lactam alternatives in patients who do not report an anaphylactic reaction can lead to increased antimicrobial resistance. In fact, a retrospective cohort study involving over 21,000 women undergoing hysterectomy demonstrated that the use of standard β-lactam antibiotics had a lower risk of SSI compared to those who received an alternative regimen [23]. Thus, we advise judicious use of β-lactam alternatives for patients with a history of IgE-mediated penicillin hypersensitivity. The most common organisms isolated from vaginal cuff infections are anaerobes. In a large retrospective cohort study with over 18,000 patients undergoing hysterectomy of any type, those receiving cefazolin or a second-generation cephalosporin have more than double the SSI risk compared with those receiving combined treatment with cefazolin and metronidazole [25]. This is likely related to enhanced anaerobic coverage with the addition of metronidazole. We recommend that all patients undergoing hysterectomy receive metronidazole in addition to the standard intraoperative antibiotics.
