SCIENTIFIC
Incidence of Bacterial Vaginosis Prior to Hysterectomy— Should We Standardize Screening?
AUTHORS: Abigail Rosiello, MD Edith Henderson, MD Christina Markopoulos, BS Mahreen Hashmi, MD
AFFILIATIONS:
Department of Obstetrics & Gynecology, West Virginia University
CORRESPONDING AUTHOR:
Abigail Rosiello, MD Email: atrosiello @ hsc. wvu. edu
DISCLOSURES:
The authors declare no conflicts of interest related to this work.
ETHICS STATEMENT:
This study was approved by the IRB of West Virginia University( Protocol Number 2001871015). Written informed consent was obtained from all participants.
FUNDING:
There was no funding provided for this study.
INTRODUCTION
According to recent data, approximately 2-3 % of hysterectomies are complicated by surgical site infections( SSIs). 1 Of SSIs, approximately 25 % occur in the deep organ space and can affect the vaginal cuff. 2, 3 The most common culprits of vaginal cuff infections are anaerobic bacteria like Gardnerella vaginalis, Bacteroides spp, Prevotella spp, and Peptostreptococcus spp. 1, 4 Vaginal cuff infections can lead to serious complications such as pelvic abscess development or vaginal cuff dehiscence, serving as a major cause of morbidity in gynecologic surgery. 2, 5
Bacterial vaginosis( BV) is a condition of overgrowth of anaerobic bacteria, when the vaginal microflora becomes
ABSTRACT
INTRODUCTION
Vaginal cuff infections are well-known complications of laparoscopic hysterectomies. An implicated etiology is bacterial vaginosis( BV), a condition where the vaginal microflora is predominated by anaerobic bacteria. Studies have demonstrated increased postoperative pelvic infection in patients with BV at time of hysterectomy. However, no guidelines exist at our institution to guide screening for BV for patients undergoing hysterectomy. Therefore, a prospective observational study was implemented at our academic institution to determine the incidence of BV in our pre-operative patients and to identify the association of a positive pre-operative BV screen with postoperative infection.
METHODS
Institutional review board approval was obtained. Patients undergoing minimally invasive benign hysterectomy were recruited, and they provided informed consent. An intraoperative
imbalanced and the predominant hydrogen peroxide-producing lactobacilli disappear. 4, 6, 7 Organisms implicated in the development of BV are some of the same organisms involved in vaginal cuff infections, including Gardnerella vaginalis and others like Fusobacterium species and Atopobium vaginae. 7 BV can cause abnormal vaginal discharge, odor, itching, or burning and is typically treated with metronidazole, which is approximately 80 % effective in restoring normal vaginal flora. Left untreated, BV rarely causes complications and many patients are asymptomatic. However, the presence of BV at the time of hysterectomy has been identified as an important risk factor for developing a vaginal cuff infection. One study found that women with untreated BV at the time of hysterectomy had a three times higher risk of developing cuff cellulitis, cuff abscess, or both when compared to patients without BV. 6
wet mount and genital culture were collected, and, if positive for BV, the patient was treated postoperatively with metronidazole.
RESULTS
A sample size of 44 patients from October 2020 through March 2021 were enrolled. The incidence of BV was 25 %. Patients who received metronidazole based on detection of BV had no incidence of postoperative pelvic infection.
DISCUSSION
This data supports the need for screening patients for BV prior to hysterectomy to reduce the potential for a surgical site infection and to consider the addition of metronidazole as a preoperative antibiotic.
CONCLUSION
The findings of our single-institution pilot study provide evidence for the need for more widespread research on this topic.
Currently, the American College of Obstetrics and Gynecologist( ACOG) recommends perioperative screening and treatment for BV as this has been shown to decrease vaginal cuff infections following hysterectomy. 6 Despite recommended evidence, this screening is not routinely performed at our institution. To understand the impact of BV on postoperative infection following benign hysterectomies at our academic institution, a pilot study was created with the following primary aims: to determine the prevalence of asymptomatic BV in patients undergoing hysterectomy and to determine if BV was associated with the development of a postoperative pelvic infection. The secondary aim was to establish the rationale for institution-wide screening and advocate for the addition of metronidazole to routine antibiotics given for benign hysterectomies.
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