human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: A prospect i ve , r and omized , multicenter study was conducted on the efficacy and safety of two prophylactic antibiotic regimens in both abdominal and vaginal hysterectomy . Patients received three intravenous doses of clindamycin ( 900 mg ) plus either aztreonam ( 1 g ) or cefotaxime ( 1 g ) ; the doses were given at the induction of anesthesia and 8 and 16 hours later . A total of 170 patients undergoing abdominal hysterectomy and 142 patients undergoing vaginal hysterectomy completed the trial and were evaluated . Following abdominal hysterectomy infections occurred at the operative site in 1.2 % of patients given a regimen including aztreonam and in 4.7 % of those given a regimen including cefotaxime ; the difference between the two groups was not significant . Neither were significant differences observed in the incidence of fever , the incidence of bacteriuria , the need for postoperative antibiotics , or the duration of postoperative hospitalization , although results were slightly better for patients receiving clindamycin plus aztreonam . Following vaginal hysterectomy , slightly but not significantly better results for the same parameters were obtained in the group given clindamycin plus cefotaxime .  Diarrhea was the only adverse reaction attributable to antibiotic treatment and occurred more frequently in patients given cefotaxime . It was concluded that the two regimens were similarly effective and safe in preventing infections following hysterectomy Abstract .Fram KM . Laparoscopically assisted vaginal hysterectomy versus abdominal hysterectomy in stage I endometrial cancer . The purpose of this study was to evaluate and compare laparoscopic treatment for stage I endometrial cancer with the traditional transabdominal approach . From July 1996 to July 1998 , 61 patients with clinical stage I endometrial cancer were treated at the Gynaecology Oncology Unit at the Royal North Shore of Sydney , Australia . Twenty-nine patients were treated with laparoscopic assisted vaginal hysterectomy ( LAVH ) and bilateral salpingo-oophrectomy ( BSO ) ± laparoscopic pelvic lymphadenectomy ( LPLA ) , while 32 patients were treated with the traditional laparotomy and underwent total abdominal hysterectomy ( TAH ) and BSO ± pelvic lymphadenectomy ( PLA ) . The main outcomes studied were operative time , blood loss , blood transfusion , intraoperative complications , postoperative complications , duration of hospital stay , and number of lymph nodes obtained . In conclusion , laparoscopic treatment of endometrial cancer is safe in the h and s of experienced operators with minimal intraoperative and postoperative complications . This procedure is associated with significantly less blood loss and shorter hospitalization ; however , it is associated with significantly longer operating time . Proper selection of patients for the laparoscopic procedure is the vital step in achieving the major goals of this approach OBJECTIVE The purpose of this study was to determine if antibiotic prophylaxis with nitrofurantoin monohydrate macrocrystals ( study drug ) after pelvic organ prolapse and /or urinary incontinence surgery with suprapubic catheterization ( SPC ) decreases urinary tract infection ( uti ) compared with placebo in a r and omized , double-blind , multicenter trial . STUDY DESIGN Six centers participated in this study . After a negative preoperative urine culture , history , surgical and postoperative course , urine culture and symptoms at SPC removal , and at 6 to 8 weeks postoperative , any other UTI and adherence were recorded . To demonstrate a 50 % decrease in the bacteruria rate from 20 % , with 80 % power and alpha of 0.05 , 438 patients were required . Data were evaluated with Student t test and Fisher exact test . RESULTS Of 449 patients enrolled , 211 r and omized to study drug , and 224 r and omized to placebo . No pre- or perioperative differences existed between groups ( all P>.05 ) . Antibiotic prophylaxis decreased positive urine cultures compared with placebo ( 46 % vs 61 % , P=.002 ) , symptomatic UTI at SPC removal ( 7.2 % vs 19.8 % , P=.001 ) , and any other symptomatic UTI 6 to 8 weeks postoperatively ( 18.9 % vs 32.6 % , P=.002 ) . Antibiotic prophylaxis did not decrease symptomatic UTI at the 6- to 8-week postoperative visit ( 1.8 % vs 5.4 % , P=.10 ) . CONCLUSION Antibiotic prophylaxis with nitrofurantoin monohydrate macrocrystals decreases UTI compared with placebo after pelvic organ prolapse and /or urinary incontinence surgery with suprapubic catheterization OBJECTIVE To compare the effectiveness of ceftriaxone versus cefazolin for the prevention of febrile morbidity and postoperative infections among patients after abdominal hysterectomy . METHODS In a double-blind , r and omized , controlled trial in Bangkok , Thail and , 320 patients undergoing abdominal hysterectomy between July 2008 and July 2009 were r and omly assigned to receive 1 g of either ceftriaxone or cefazolin intravenously in a single dose before surgery . The participants were evaluated for postoperative fever and infection for up to 4 weeks . χ(2 ) or Fisher exact tests were used for statistical analysis . RESULTS There was no significant difference between the ceftriaxone and cefazolin groups in incidence of febrile morbidity ( 9.4 % versus 11.2 % ) , wound infection ( 3.8 % versus 1.9 % ) , vaginal cuff infection ( 3.8 % versus 1.9 % ) , or urinary tract infection ( 1.9 % versus 1.9 % ) . CONCLUSION There was no difference between the use of single-dose preoperative ceftriaxone and cefazolin in preventing infectious morbidity among patients undergoing hysterectomy Two hundred fourteen women having vaginal or abdominal hysterectomy were entered into a prospect i ve , r and omized , blind clinical trial comparing a preoperative intravenous dose of piperacillin to three perioperative intravenous doses of cefoxitin given over an eight-hour period . Interregimen clinical , surgical , and outcome variables of the 207 evaluable subjects were statistically similar , but there were significant interprocedure differences in a variety of categories ; many benefits exist when vaginal hysterectomy is possible . Efficacy of a single dose of piperacillin was similar to that of three cefoxitin doses . Seven women ( 3.4 % ) had major postoperative infection requiring parenteral antimicrobial  therapy , two ( 1.9 % ) after vaginal hysterectomy and five ( 4.8 % ) after abdominal hysterectomy . Three of the latter five infections ( 60 % ) occurred after discharge from the hospital . Even with prophylaxis , postoperative anemia was associated with increased frequency of infection at the operative site after both procedures , and diabetes was associated with late infection of the abdominal incision after abdominal hysterectomy A r and omized double-blind prospect i ve study on the efficacy of single-dose antibiotic prophylaxis compared cefuroxime versus metronidazole versus the combination of both agents in vaginal hysterectomy . Overall antibiotic prophylaxis was effective in abscess prevention ( one abscess in 68 patients ) . In the metronidazole group a significantly higher grade of morbidity was observed : febrile morbidity 41 % versus 4 % in the two other groups ; bacteriuria 73 % versus 17 % in the cefuroxime group , versus 13 % in the combined group ; urinary tract infection 23 % , versus 0 % in the two other groups ; post-operative prescription of antibiotics 41 % , versus 0 % in the two other groups . Febrile morbidity and bacteriuria correlated positively withEscherichia coli and Proteus spp . These micro-organisms were recovered significantly more often from the vagina of patients in the metronidazole group . Cefuroxime was successful , metronidazole failed in the prevention of minor morbidity . We could not observe any effect from the addition of metronidazole to the cefuroxime prophylaxis Antimicrobial prophylaxis is recommended in all clean-contaminated surgery where the critical threshold of number and virulence of the contaminating organisms with respect to host resistance is reached . Obstetric and gynaecological surgery is clean-contaminated and risk of infection due to aerobic and anaerobic bacteria without prophylaxis can be quantified at 30 - 40 % for vaginal hysterectomy , 10 - 35 % for abdominal hysterectomy and 10 - 34 % for caesarean section . To assess the role of two different cephalosporins as short term prophylaxis , we carried out a multicentre r and omised study involving a single 2 g i.v . dose of cefotetan in comparison with two doses of cefazolin ( 2 g i.v . before surgery and after 8 hours ) . Criteria for exclusion were : exposure to antibiotics within 7 days , preoperative infection , hypersensitivity to beta-lactams . Four hundred and sixty patients entered the study , of which 229 received  cefotetan and 231 cefazolin . No significant differences in mean age , obesity , preoperative weight loss , diabetes , type of disease , type of surgery ( vaginal or abdominal hysterectomies and caesarean sections ) and number of pregnancies and abortions existed between the two groups of patients . The total rate of infected patients undergoing hysterectomy  was 8.6 % ( 13/151 ) in the cefotetan group and 17.4 % ( 29/167 ) in the cefazolin group ( p less than 0.05 ) . This difference was due to cases of symptomatic bacteriuria and antibiotic retreatment , while wound infections were not significantly different ( 2.6 % and 1.8 % respectively ) . Among patients undergoing caesarean section , 9 of 78 ( 11.5 % ) and 7 of 64 ( 10.9 % ) were infected following cefotetan and cefazolin , respectively ( not significant ) . Cefotetan mean tissue concentrations in gynaecological organs were higher than those of cefazolin ( 25.5 - 44.8 vs. 7.4 - 9.5 mg/kg ) . ( ABSTRACT TRUNCATED AT 250 WORDS Abstract Numerous studies have been published in recent years about antimicrobial prophylaxis in gynecologic surgery , but the optimal drug and schedule for the different surgical procedures is still a matter of debate . The aim of the present study was to compare two ultra-short term antimicrobial prophylaxis regimens ( amoxicillin-clavulanic acid and cefazolin ) in preventing infections following laparoscopic gynecologic operations . Three hundred sixty women hospitalized for a laparoscopic gynecologic surgery procedure were included in the study between January 1999 , and December 2001 . Patients were r and omly allocated to receive amoxicillin-clavulanic acid ( 2.2 g ) [ Group A ] or cefazolin ( 2 g ) [ Group B ] as a single dose 30 minutes before surgery . Each patient was assessed daily until discharge to evidence febrile status and the presence of infections at the operative site , urinary tract and respiratory tract . In the amoxicillin-clavulanic acid ( Group A ) and cefazolin ( Group B ) groups , overall 164 and 172 patients , respectively , were evaluable for prophylactic efficacy at hospital discharge . Infectious complications were infrequent in both groups with febrile morbidity occurring in only one patient ( 0.6 % ) in the amoxicillin- clavulanic group . No sign of infections at the surgical site , urinary tract and respiratory tract was observed in either group . No death due to sepsis was recorded . It is concluded that ultra-short term prophylaxis with both amoxicillin-clavulanic acid and cefazolin is safe and effective in elective laparoscopic gynecologic surgery Although hysterectomy was the most frequently performed major surgical procedure among women of reproductive age during the past decade , few recent studies have been conducted to determine the risk of complications . We examined data from the Collaborative Review of Sterilization , a prospect i ve , multicenter , observational study coordinated by the Centers for Disease Control , to assess the comparative risks of complications among women undergoing hysterectomy by the abdominal and vaginal approaches . Between September , 1978 , and August , 1981 , 1,851 women from nine institutions were included in the study . Women who underwent vaginal hysterectomy  experienced significantly fewer complications than women who had undergone  abdominal hysterectomy . The difference was probably attributable to the prevalence and efficacy of prophylactic antibiotic use among the former group . Vaginal hysterectomy was associated with more unintended major surgical procedures but less febrile morbidity , bleeding requiring transfusion , hospitalization , and convalescence than abdominal h 
    Output:
    
agent
Results Prophylactic antibiotics  prevent inflammatory complications after gynaecological surgery .
Prophylactic antibiotics are more effective in surgery requiring access to the peritoneal cavity or the vagina .
Cefotetan appears to be more capable in preventing the overall inflammatory complication rate than cefoxitin or cefazolin .
No benefit has been shown for the combination of antibiotics as prophylaxis .
No difference has been shown between the long-term and short-term use of antibiotics .
There is no need for the primary use of an anaerobic antibacterial agent .
Conclusion Antibiotics help to prevent postoperative inflammatory complications after major gynecologic surgeries
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: A prospect i ve , r and omized , multicenter study was conducted on the efficacy and safety of two prophylactic antibiotic regimens in both abdominal and vaginal hysterectomy . Patients received three intravenous doses of clindamycin ( 900 mg ) plus either aztreonam ( 1 g ) or cefotaxime ( 1 g ) ; the doses were given at the induction of anesthesia and 8 and 16 hours later . A total of 170 patients undergoing abdominal hysterectomy and 142 patients undergoing vaginal hysterectomy completed the trial and were evaluated . Following abdominal hysterectomy infections occurred at the operative site in 1.2 % of patients given a regimen including aztreonam and in 4.7 % of those given a regimen including cefotaxime ; the difference between the two groups was not significant . Neither were significant differences observed in the incidence of fever , the incidence of bacteriuria , the need for postoperative antibiotics , or the duration of postoperative hospitalization , although results were slightly better for patients receiving clindamycin plus aztreonam . Following vaginal hysterectomy , slightly but not significantly better results for the same parameters were obtained in the group given clindamycin plus cefotaxime .  Diarrhea was the only adverse reaction attributable to antibiotic treatment and occurred more frequently in patients given cefotaxime . It was concluded that the two regimens were similarly effective and safe in preventing infections following hysterectomy Abstract .Fram KM . Laparoscopically assisted vaginal hysterectomy versus abdominal hysterectomy in stage I endometrial cancer . The purpose of this study was to evaluate and compare laparoscopic treatment for stage I endometrial cancer with the traditional transabdominal approach . From July 1996 to July 1998 , 61 patients with clinical stage I endometrial cancer were treated at the Gynaecology Oncology Unit at the Royal North Shore of Sydney , Australia . Twenty-nine patients were treated with laparoscopic assisted vaginal hysterectomy ( LAVH ) and bilateral salpingo-oophrectomy ( BSO ) ± laparoscopic pelvic lymphadenectomy ( LPLA ) , while 32 patients were treated with the traditional laparotomy and underwent total abdominal hysterectomy ( TAH ) and BSO ± pelvic lymphadenectomy ( PLA ) . The main outcomes studied were operative time , blood loss , blood transfusion , intraoperative complications , postoperative complications , duration of hospital stay , and number of lymph nodes obtained . In conclusion , laparoscopic treatment of endometrial cancer is safe in the h and s of experienced operators with minimal intraoperative and postoperative complications . This procedure is associated with significantly less blood loss and shorter hospitalization ; however , it is associated with significantly longer operating time . Proper selection of patients for the laparoscopic procedure is the vital step in achieving the major goals of this approach OBJECTIVE The purpose of this study was to determine if antibiotic prophylaxis with nitrofurantoin monohydrate macrocrystals ( study drug ) after pelvic organ prolapse and /or urinary incontinence surgery with suprapubic catheterization ( SPC ) decreases urinary tract infection ( uti ) compared with placebo in a r and omized , double-blind , multicenter trial . STUDY DESIGN Six centers participated in this study . After a negative preoperative urine culture , history , surgical and postoperative course , urine culture and symptoms at SPC removal , and at 6 to 8 weeks postoperative , any other UTI and adherence were recorded . To demonstrate a 50 % decrease in the bacteruria rate from 20 % , with 80 % power and alpha of 0.05 , 438 patients were required . Data were evaluated with Student t test and Fisher exact test . RESULTS Of 449 patients enrolled , 211 r and omized to study drug , and 224 r and omized to placebo . No pre- or perioperative differences existed between groups ( all P>.05 ) . Antibiotic prophylaxis decreased positive urine cultures compared with placebo ( 46 % vs 61 % , P=.002 ) , symptomatic UTI at SPC removal ( 7.2 % vs 19.8 % , P=.001 ) , and any other symptomatic UTI 6 to 8 weeks postoperatively ( 18.9 % vs 32.6 % , P=.002 ) . Antibiotic prophylaxis did not decrease symptomatic UTI at the 6- to 8-week postoperative visit ( 1.8 % vs 5.4 % , P=.10 ) . CONCLUSION Antibiotic prophylaxis with nitrofurantoin monohydrate macrocrystals decreases UTI compared with placebo after pelvic organ prolapse and /or urinary incontinence surgery with suprapubic catheterization OBJECTIVE To compare the effectiveness of ceftriaxone versus cefazolin for the prevention of febrile morbidity and postoperative infections among patients after abdominal hysterectomy . METHODS In a double-blind , r and omized , controlled trial in Bangkok , Thail and , 320 patients undergoing abdominal hysterectomy between July 2008 and July 2009 were r and omly assigned to receive 1 g of either ceftriaxone or cefazolin intravenously in a single dose before surgery . The participants were evaluated for postoperative fever and infection for up to 4 weeks . χ(2 ) or Fisher exact tests were used for statistical analysis . RESULTS There was no significant difference between the ceftriaxone and cefazolin groups in incidence of febrile morbidity ( 9.4 % versus 11.2 % ) , wound infection ( 3.8 % versus 1.9 % ) , vaginal cuff infection ( 3.8 % versus 1.9 % ) , or urinary tract infection ( 1.9 % versus 1.9 % ) . CONCLUSION There was no difference between the use of single-dose preoperative ceftriaxone and cefazolin in preventing infectious morbidity among patients undergoing hysterectomy Two hundred fourteen women having vaginal or abdominal hysterectomy were entered into a prospect i ve , r and omized , blind clinical trial comparing a preoperative intravenous dose of piperacillin to three perioperative intravenous doses of cefoxitin given over an eight-hour period . Interregimen clinical , surgical , and outcome variables of the 207 evaluable subjects were statistically similar , but there were significant interprocedure differences in a variety of categories ; many benefits exist when vaginal hysterectomy is possible . Efficacy of a single dose of piperacillin was similar to that of three cefoxitin doses . Seven women ( 3.4 % ) had major postoperative infection requiring parenteral antimicrobial  therapy , two ( 1.9 % ) after vaginal hysterectomy and five ( 4.8 % ) after abdominal hysterectomy . Three of the latter five infections ( 60 % ) occurred after discharge from the hospital . Even with prophylaxis , postoperative anemia was associated with increased frequency of infection at the operative site after both procedures , and diabetes was associated with late infection of the abdominal incision after abdominal hysterectomy A r and omized double-blind prospect i ve study on the efficacy of single-dose antibiotic prophylaxis compared cefuroxime versus metronidazole versus the combination of both agents in vaginal hysterectomy . Overall antibiotic prophylaxis was effective in abscess prevention ( one abscess in 68 patients ) . In the metronidazole group a significantly higher grade of morbidity was observed : febrile morbidity 41 % versus 4 % in the two other groups ; bacteriuria 73 % versus 17 % in the cefuroxime group , versus 13 % in the combined group ; urinary tract infection 23 % , versus 0 % in the two other groups ; post-operative prescription of antibiotics 41 % , versus 0 % in the two other groups . Febrile morbidity and bacteriuria correlated positively withEscherichia coli and Proteus spp . These micro-organisms were recovered significantly more often from the vagina of patients in the metronidazole group . Cefuroxime was successful , metronidazole failed in the prevention of minor morbidity . We could not observe any effect from the addition of metronidazole to the cefuroxime prophylaxis Antimicrobial prophylaxis is recommended in all clean-contaminated surgery where the critical threshold of number and virulence of the contaminating organisms with respect to host resistance is reached . Obstetric and gynaecological surgery is clean-contaminated and risk of infection due to aerobic and anaerobic bacteria without prophylaxis can be quantified at 30 - 40 % for vaginal hysterectomy , 10 - 35 % for abdominal hysterectomy and 10 - 34 % for caesarean section . To assess the role of two different cephalosporins as short term prophylaxis , we carried out a multicentre r and omised study involving a single 2 g i.v . dose of cefotetan in comparison with two doses of cefazolin ( 2 g i.v . before surgery and after 8 hours ) . Criteria for exclusion were : exposure to antibiotics within 7 days , preoperative infection , hypersensitivity to beta-lactams . Four hundred and sixty patients entered the study , of which 229 received  cefotetan and 231 cefazolin . No significant differences in mean age , obesity , preoperative weight loss , diabetes , type of disease , type of surgery ( vaginal or abdominal hysterectomies and caesarean sections ) and number of pregnancies and abortions existed between the two groups of patients . The total rate of infected patients undergoing hysterectomy  was 8.6 % ( 13/151 ) in the cefotetan group and 17.4 % ( 29/167 ) in the cefazolin group ( p less than 0.05 ) . This difference was due to cases of symptomatic bacteriuria and antibiotic retreatment , while wound infections were not significantly different ( 2.6 % and 1.8 % respectively ) . Among patients undergoing caesarean section , 9 of 78 ( 11.5 % ) and 7 of 64 ( 10.9 % ) were infected following cefotetan and cefazolin , respectively ( not significant ) . Cefotetan mean tissue concentrations in gynaecological organs were higher than those of cefazolin ( 25.5 - 44.8 vs. 7.4 - 9.5 mg/kg ) . ( ABSTRACT TRUNCATED AT 250 WORDS Abstract Numerous studies have been published in recent years about antimicrobial prophylaxis in gynecologic surgery , but the optimal drug and schedule for the different surgical procedures is still a matter of debate . The aim of the present study was to compare two ultra-short term antimicrobial prophylaxis regimens ( amoxicillin-clavulanic acid and cefazolin ) in preventing infections following laparoscopic gynecologic operations . Three hundred sixty women hospitalized for a laparoscopic gynecologic surgery procedure were included in the study between January 1999 , and December 2001 . Patients were r and omly allocated to receive amoxicillin-clavulanic acid ( 2.2 g ) [ Group A ] or cefazolin ( 2 g ) [ Group B ] as a single dose 30 minutes before surgery . Each patient was assessed daily until discharge to evidence febrile status and the presence of infections at the operative site , urinary tract and respiratory tract . In the amoxicillin-clavulanic acid ( Group A ) and cefazolin ( Group B ) groups , overall 164 and 172 patients , respectively , were evaluable for prophylactic efficacy at hospital discharge . Infectious complications were infrequent in both groups with febrile morbidity occurring in only one patient ( 0.6 % ) in the amoxicillin- clavulanic group . No sign of infections at the surgical site , urinary tract and respiratory tract was observed in either group . No death due to sepsis was recorded . It is concluded that ultra-short term prophylaxis with both amoxicillin-clavulanic acid and cefazolin is safe and effective in elective laparoscopic gynecologic surgery Although hysterectomy was the most frequently performed major surgical procedure among women of reproductive age during the past decade , few recent studies have been conducted to determine the risk of complications . We examined data from the Collaborative Review of Sterilization , a prospect i ve , multicenter , observational study coordinated by the Centers for Disease Control , to assess the comparative risks of complications among women undergoing hysterectomy by the abdominal and vaginal approaches . Between September , 1978 , and August , 1981 , 1,851 women from nine institutions were included in the study . Women who underwent vaginal hysterectomy  experienced significantly fewer complications than women who had undergone  abdominal hysterectomy . The difference was probably attributable to the prevalence and efficacy of prophylactic antibiotic use among the former group . Vaginal hysterectomy was associated with more unintended major surgical procedures but less febrile morbidity , bleeding requiring transfusion , hospitalization , and convalescence than abdominal h 
    Output:
    