Peer-reviewedCC BY-NC 4.0Iranian Journal of Microbiology6 Nov 2026

Factors associated with surgical site infection following abdominal hysterectomy: a five-year cohort study

Farah Farzaneh¹
Fatemeh Nikpour¹
Farshad Abedi-Kebria²
Shaghayegh Hooshmand Chayijan¹
Zahra Bakhtiyari¹
Amir Soltani¹

¹Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
²Student Research Committee, School of Medicine, Babol University of Medical Sciences, Babol, Iran

Abstract

Background and Objectives:: Surgical site infection (SSI) is an important complication following hysterectomy. Given the rising antimicrobial resistance in Iran, this multi-year cohort study aimed to identify independent predictors of SSI after hysterectomy.

Materials and Methods:: This retrospective cohort study included patients undergoing total abdominal hysterectomy (2019–2024). Independent risk factors were identified via multivariable binary logistic regression. Model performance was validated using receiver operating characteristic (ROC) curve analysis. Continuous variable cut-off points were determined using the Youden index.

Results:: Among 690 patients, the SSI rate was 5.2%. Multivariable analysis identified obesity (BMI ≥ 30 kg/m2) (Adjusted Odds Ratio [aOR]: 4.11; 95% CI: 1.81–9.32; p < 0.001) and operative duration (aOR: 1.02 per minute; p < 0.001) as the strongest independent predictors. ROC analysis demonstrated excellent discrimination (AUC = 0.88). Infection risk increased critically when surgery exceeded 180 minutes or in obese patients. Preoperative non-standard antibiotic prophylaxis consisting solely of clindamycin was associated with a 7.5-fold increased SSI risk (P=.006). Microbiological analysis revealed a 30.6% prevalence of multidrug-resistant and ESBL-producing bacteria.

Conclusion:: Obesity and prolonged operative time are independent predictors of SSI. We recommend weight-based dosing, strict intraoperative re-dosing during prolonged procedures, and mandatory antimicrobial stewardship to mitigate risks associated with non-standard prophylaxis.

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Cite

BibTeX RIS

BibTeX

@article{farzaneh2026factors,
  title = {{Factors associated with surgical site infection following abdominal hysterectomy: a five-year cohort study}},
  author = {Farah Farzaneh and Fatemeh Nikpour and Farshad Abedi-Kebria and Shaghayegh Hooshmand Chayijan and Zahra Bakhtiyari and Amir Soltani},
  journal = {Iranian Journal of Microbiology},
  year = {2026},
  month = nov,
  doi = {10.18502/ijm.v18i5.22856},
  url = {https://doi.org/10.18502/ijm.v18i5.22856},
  note = {CC BY-NC 4.0},
}

RIS

TY  - JOUR
TI  - Factors associated with surgical site infection following abdominal hysterectomy: a five-year cohort study
AU  - Farah Farzaneh
AU  - Fatemeh Nikpour
AU  - Farshad Abedi-Kebria
AU  - Shaghayegh Hooshmand Chayijan
AU  - Zahra Bakhtiyari
AU  - Amir Soltani
PY  - 2026
DA  - 2026/11/06
JO  - Iranian Journal of Microbiology
DO  - 10.18502/ijm.v18i5.22856
UR  - https://doi.org/10.18502/ijm.v18i5.22856
AB  - Background and Objectives:: Surgical site infection (SSI) is an important complication following hysterectomy. Given the rising antimicrobial resistance in Iran, this multi-year cohort study aimed to identify independent predictors of SSI after hysterectomy.  Materials and Methods:: This retrospective cohort study included patients undergoing total abdominal hysterectomy (2019–2024). Independent risk factors were identified via multivariable binary logistic regression. Model performance was validated using receiver operating characteristic (ROC) curve analysis. Continuous variable cut-off points were determined using the Youden index.  Results:: Among 690 patients, the SSI rate was 5.2%. Multivariable analysis identified obesity (BMI ≥ 30 kg/m2) (Adjusted Odds Ratio [aOR]: 4.11; 95% CI: 1.81–9.32; p < 0.001) and operative duration (aOR: 1.02 per minute; p < 0.001) as the strongest independent predictors. ROC analysis demonstrated excellent discrimination (AUC = 0.88). Infection risk increased critically when surgery exceeded 180 minutes or in obese patients. Preoperative non-standard antibiotic prophylaxis consisting solely of clindamycin was associated with a 7.5-fold increased SSI risk (P=.006). Microbiological analysis revealed a 30.6% prevalence of multidrug-resistant and ESBL-producing bacteria.  Conclusion:: Obesity and prolonged operative time are independent predictors of SSI. We recommend weight-based dosing, strict intraoperative re-dosing during prolonged procedures, and mandatory antimicrobial stewardship to mitigate risks associated with non-standard prophylaxis.
SN  - 2008-3289
SN  - 2008-4447
ER  -

Abstract

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