Introduction/Background Intraoperative subcutaneous wound cultures before skin closure may help early recognition and prevention of surgical site infection in open gynecological procedures. The objective was analyze the relationship between intraoperative skin and subcutaneous cultures and the development of surgical site infection (SSI) in women undergoing laparotomy for gynecological surgery.

Methodology Women who underwent elective laparotomy between January 2012 and December 2017 at our hospital, were included in the study. Skin and subcutaneous samples were taken just prior to skin closure. Patients‘ demographics, underlying co-morbidities, surgical variables, intraoperative cultures results and 30-days postoperative SSI’s were collected. Univariate and multivariate analyses (logistic regression models) were conducted to explore the association of the studied variables with SSI’s after laparotomy and with positive intraoperative cultures.

Results A total of 343 patients were included in our study, of which 25 (7.3%) developed SSI, including 15 (60%) superficial and 10 (40%) organ-space. At univariate analysis, contaminated surgery (P=0.004), length of surgery (P=0.049), transfusions (P=0.006), intra-abdominal drains (P=0.01), days with drainage (P=0.047) and length of hospitalization (P=0.04) were associated with SSI occurrence. Of the 264 women who had skin and subcutaneous cultures obtained, 20 (7.6%) developed SSI. Skin and subcutaneous cultures were positive in 23 (9.2%) and 20 (7.1%) patients, respectively. The most frequently isolated bacteria were intestinal microbiota. SSI occurred in 35% (7/20) of women with positive subcutaneous cultures versus 4.9% (13/264) with negative culture (P<0.0001); and in 20% (5/25) of those with positive skin cultures versus 5.8% (15/259) with negative culture (P<0.0001). Using multivariate analysis, the only independent risk factor for SSI was a positive subcutaneous culture (OR 6.3; 95% CI 1.6–24.8; P=0.009).

Conclusion Intraoperative identification of potential infectious pathogens with subcutaneous wound cultures before skin closure may help early recognition and prevention of SSI in open gynecological procedures.

Disclosure Nothing to disclose.