Incidence of postoperative fever and bloodstream infections in gynecological surgical patients: a three-year retrospective surveillance

Incidence of postoperative fever and bloodstream infections in gynecological surgical patients: a three-year retrospective surveillance | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Incidence of postoperative fever and bloodstream infections in gynecological surgical patients: a three-year retrospective surveillance Yunxin Gong, Ping Luo, Xuesong Wang, Huarong Zeng, Qiulu Xiang, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6917920/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 29 Dec, 2025 Read the published version in BMC Infectious Diseases → Version 1 posted 13 You are reading this latest preprint version Abstract Background Postoperative fever (PF) and postoperative bloodstream infections (PBSIs) are common and severe complications following gynecological surgery, yet they receive less focus than surgical site infections. This study aimed to determine the incidence, etiology, and modifiable risk factors to establish an evidence-based foundation for clinical prevention and control. Methods We conducted a three-year (2022–2024) retrospective surveillance of 19,906 patients who underwent gynecological surgery at a large tertiary hospital in China. Electronic medical records were analyzed to calculate the incidence rate of PF and PBSIs, identify pathogens from blood cultures, and assess correlations between incidence rates and process measures, including preoperative vaginal preparation and prophylactic antimicrobial administration. Results The overall incidence was 2.67% for PF and 1.30% for PBSIs. Escherichia coli was the predominant pathogen in PBSIs (70.37% of isolates), exhibiting high resistance to first- and second-generation cephalosporins but remaining susceptible to carbapenems and β-lactam/β-lactamase inhibitors. The rate of preoperative vaginal preparation was significantly and negatively correlated with PBSI incidence (ρ = -0.50, P = 0.002), whereas the rate of preoperative prophylactic antimicrobial administration showed no significant correlation. Infection risk was significantly higher for surgeries involving the gastrointestinal tract and during the third and fourth quarters of the year. Conclusions A multi-faceted strategy is essential to prevent PBSIs. Routine preoperative vaginal preparation is a critical protective measure. The ineffectiveness of standard antibiotic prophylaxis is likely due to the high resistance of the primary pathogen, Escherichia coli , underscoring the need for stewardship guided by local antibiograms. Future research should aim to define optimal protocols for vaginal preparation. Gynecological surgery Preoperative vaginal preparation Postoperative fever Postoperative bloodstream infection Retrospective surveillance Full Text Additional Declarations Table 1 to 4 are available in the Supplementary Files section. Supplementary Files Table1.docx Table2.docx Table3.docx Table4.docx Cite Share Download PDF Status: Published Journal Publication published 29 Dec, 2025 Read the published version in BMC Infectious Diseases → Version 1 posted Editorial decision: Revision requested 14 Oct, 2025 Reviews received at journal 07 Aug, 2025 Reviewers agreed at journal 03 Aug, 2025 Reviews received at journal 03 Aug, 2025 Reviewers agreed at journal 03 Aug, 2025 Reviewers agreed at journal 29 Jul, 2025 Reviews received at journal 29 Jul, 2025 Reviewers agreed at journal 29 Jul, 2025 Reviewers invited by journal 29 Jul, 2025 Editor assigned by journal 23 Jul, 2025 Editor invited by journal 30 Jun, 2025 Submission checks completed at journal 29 Jun, 2025 First submitted to journal 29 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6917920","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":492991598,"identity":"171f2e3d-9d05-4a48-98e4-802dc5a8db58","order_by":0,"name":"Yunxin Gong","email":"","orcid":"","institution":"Sichuan Provincial People's Hospital Pujiang Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yunxin","middleName":"","lastName":"Gong","suffix":""},{"id":492991599,"identity":"bb6d9fc9-ce78-4f7a-957d-c9ea04008428","order_by":1,"name":"Ping Luo","email":"","orcid":"","institution":"The First Affiliated Hospital of 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surveillance","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Gynecological surgery, Preoperative vaginal preparation, Postoperative fever, Postoperative bloodstream infection, Retrospective surveillance","lastPublishedDoi":"10.21203/rs.3.rs-6917920/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6917920/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003ePostoperative fever (PF) and postoperative bloodstream infections (PBSIs) are common and severe complications following gynecological surgery, yet they receive less focus than surgical site infections. This study aimed to determine the incidence, etiology, and modifiable risk factors to establish an evidence-based foundation for clinical prevention and control.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe conducted a three-year (2022\u0026ndash;2024) retrospective surveillance of 19,906 patients who underwent gynecological surgery at a large tertiary hospital in China. Electronic medical records were analyzed to calculate the incidence rate of PF and PBSIs, identify pathogens from blood cultures, and assess correlations between incidence rates and process measures, including preoperative vaginal preparation and prophylactic antimicrobial administration.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe overall incidence was 2.67% for PF and 1.30% for PBSIs. \u003cem\u003eEscherichia coli\u003c/em\u003e was the predominant pathogen in PBSIs (70.37% of isolates), exhibiting high resistance to first- and second-generation cephalosporins but remaining susceptible to carbapenems and β-lactam/β-lactamase inhibitors. The rate of preoperative vaginal preparation was significantly and negatively correlated with PBSI incidence (ρ = -0.50, P\u0026thinsp;=\u0026thinsp;0.002), whereas the rate of preoperative prophylactic antimicrobial administration showed no significant correlation. Infection risk was significantly higher for surgeries involving the gastrointestinal tract and during the third and fourth quarters of the year.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eA multi-faceted strategy is essential to prevent PBSIs. Routine preoperative vaginal preparation is a critical protective measure. The ineffectiveness of standard antibiotic prophylaxis is likely due to the high resistance of the primary pathogen, \u003cem\u003eEscherichia coli\u003c/em\u003e, underscoring the need for stewardship guided by local antibiograms. Future research should aim to define optimal protocols for vaginal preparation.\u003c/p\u003e","manuscriptTitle":"Incidence of postoperative fever and bloodstream infections in gynecological surgical patients: a three-year retrospective surveillance","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-31 21:13:35","doi":"10.21203/rs.3.rs-6917920/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-14T20:02:25+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-07T06:45:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"233047621859949211707164684061864379955","date":"2025-08-03T16:14:46+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-03T07:40:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"254574478639749379056312123062044908924","date":"2025-08-03T06:40:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"306468015354836321637927386977820261334","date":"2025-07-29T20:16:34+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-29T15:30:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"102185014207593892903068746222167489158","date":"2025-07-29T14:40:54+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-29T07:46:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-23T11:05:47+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-30T10:56:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-30T03:33:51+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Infectious Diseases","date":"2025-06-30T02:54:46+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"510c9cca-6a49-4c88-b764-8e76cd353282","owner":[],"postedDate":"July 31st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-05T16:00:58+00:00","versionOfRecord":{"articleIdentity":"rs-6917920","link":"https://doi.org/10.1186/s12879-025-12461-6","journal":{"identity":"bmc-infectious-diseases","isVorOnly":false,"title":"BMC Infectious Diseases"},"publishedOn":"2025-12-29 15:57:53","publishedOnDateReadable":"December 29th, 2025"},"versionCreatedAt":"2025-07-31 21:13:35","video":"","vorDoi":"10.1186/s12879-025-12461-6","vorDoiUrl":"https://doi.org/10.1186/s12879-025-12461-6","workflowStages":[]},"version":"v1","identity":"rs-6917920","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6917920","identity":"rs-6917920","version":["v1"]},"buildId":"veTbxFhMMB0_faC6-Wkog","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}