Comparison of Cefazolin versus Ceftriaxone for Surgical Site Infection Prevention and Predictors of Surgical Site Infection in Gynecologic Surgery.

BACKGROUND

Surgical site infection (SSI) is a significant postoperative complication in gynecological surgery, increasing morbidity, mortality, and healthcare costs. This study aimed to compare postoperative surgical site infection (SSI) outcomes between patients receiving cefazolin or ceftriaxone as preoperative antibiotics and to identify clinical predictors of postoperative SSI.

METHODS

This retrospective cohort study involved 366 gynecological surgery patients at Dr. Hasan Sadikin General Hospital, Bandung. Medical record data were analyzed using bivariate analysis and multivariable logistic regression. Variables analyzed included age, body mass index (BMI), hemoglobin, leukocyte count, neutrophil-to-lymphocyte ratio (NLR), and type of antibiotic used (cefazolin or ceftriaxone). The primary outcome was postoperative surgical site infection documented during postoperative follow-up.

RESULTS

No significant difference was found between cefazolin and ceftriaxone in the incidence of surgical site infection (p = 0.097). However, several clinical parameters were significantly associated with SSI. A BMI > 24.89 kg/m2 was associated with an odds ratio (OR) of 4.27 (95% CI: 2.74-6.65). Leukocyte count > 12,580/μL had an OR of 2.31 (95% CI: 1.44-3.69). An NLR > 14.68 showed an OR of 2.53 (95% CI: 1.65-3.89). Lower hemoglobin levels (<11.9 g/dL) were associated with an OR of 2.70 (95% CI: 1.67-4.35), while hematocrit ≤32.5% showed an OR of 2.47 (95% CI: 1.58-3.87). The area under the curve (AUC) value for NLR was 0.641, indicating modest discriminative ability in predicting SSI.

DISCUSSION: Cefazolin and ceftriaxone were associated with comparable postoperative SSI outcomes in this retrospective cohort. Considering antimicrobial stewardship principles and Indonesian national guidelines, cefazolin may be preferred as the first-line preoperative antibiotic. Higher BMI, leukocytosis, elevated NLR, and anemia were associated with an increased risk of SSI and may help identify patients at greater postoperative risk.

CONCLUSION

Cefazolin and ceftriaxone showed comparable postoperative SSI outcomes in this retrospective cohort. BMI, hemoglobin level, hematocrit, and NLR were independent predictors of postoperative SSI.