Empirical Antibiotic Treatment of Obstetric and Gynecologic Surgical Site Infections: Are the Right Pathogens Being Targeted?

Objective: The aim of this research was to assess the microbiologic diversity and the adequacy of empirical antibiotic treatment of surgical site infections (SSIs) following cesarean sections (CS) and abdominal gynecologic operations. Materials and Methods: A retrospective single-center study was conducted between January 2011 and December 2014. Medical records of all patients with positive SSI cultures following CS or laparotomies for gynecologic indications were reviewed. The adequacy of empirical antibiotic treatment was assessed with antibiotic susceptibility testing results of the isolated pathogens. Results: The empirical drugs of choice were a first-generation cephalosporin and amoxicillin-clavulanic acid. Of the 178 positive cultures 99 (55.8%) were obtained from 72 post-CS patients and 79 (44.2%) from 49 post-gynecologic operation patients. The most common pathogens in both groups were enterobacteriaceae, with notable variance in the rate of Staphylococcus aureus between the groups (30.3% versus 6.3%, respectively). In up to 55% of the patients in both groups (62.5% of post-CS patients and 44.8% of post-gynecologic operation patients), inadequate empirical antibiotic treatment was administered. Conclusions: Variance in post-CS and post-gynecologic procedure SSIs may render the current uniform empirical antibiotic treatment suboptimal. Assessment of local flora and resistance patterns should dictate tailor-made protocols for both SSI groups.