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

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.