{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T04:26:08Z","timestamp":1787199968040,"version":"build-2736575974"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["22476032"],"award-info":[{"award-number":["22476032"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100018542","name":"Natural Science Foundation of Sichuan Province","doi-asserted-by":"publisher","award":["2023NSFSC0534"],"award-info":[{"award-number":["2023NSFSC0534"]}],"id":[{"id":"10.13039\/501100018542","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Postoperative systemic infectious complications (PSIC) impose a substantial burden on clinical resources following gynecologic surgery. While international guidelines recommend preoperative vaginal preparation, high-quality evidence supporting its efficacy against PSIC remains limited. Furthermore, uptake varies widely in practice, often reflecting healthcare reform priorities such as Diagnosis-Related Groups (DRG) and Diagnosis-Intervention Packet (DIP).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study of 17,582 gynecologic surgery patients (January 2022\u2013December 2024) at a southwestern Chinese tertiary hospital. Propensity score matching (PSM) produced 2,195 balanced pairs. The study outcome was the incidence of PSIC, assessed using an objective, EMR-based algorithmic definition.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Vaginal preparation reduced PSIC incidence by nearly half (1.28% vs. 2.19%; adjusted OR\u00a0=\u00a00.623, 95% CI: 0.385\u20130.919, p = 0.040). The protective effect was robust across pre-specified subgroups, with marked risk reductions observed among patients undergoing open surgery, those using prophylactic antibiotics, anemic patients, and non-diabetics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Preoperative vaginal preparation reduced PSIC risk in this real-world cohort. This intervention proved particularly valuable for specific patient and procedural subgroups. As a cost-effective measure, it warrants inclusion in routine preoperative protocols, even within efficiency-driven frameworks such as Enhanced Recovery After Surgery (ERAS) and DRG\/DIP.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcimb.2026.1847878","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T04:15:30Z","timestamp":1787199330000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Preoperative vaginal preparation reduces postoperative systemic infectious complications in gynecologic surgery: a propensity score-matched retrospective cohort study"],"prefix":"10.3389","volume":"16","author":[{"given":"Xiaojia","family":"Zheng","sequence":"first","affiliation":[{"name":"Healthcare-associated Infection Control Center, Sichuan Academy of Medical Sciences, Sichuan Provincial People\u2019s Hospital, School of Medicine, University of Electronic Science and Technology of China","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liping","family":"Xu","sequence":"additional","affiliation":[{"name":"Hospital Infection Control Department, Sichuan Provincial People\u2019s Hospital Pujiang Hospital-Pujiang People\u2019s Hospital","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin","family":"Peng","sequence":"additional","affiliation":[{"name":"Hospital Infection Control Department, Sichuan Provincial People\u2019s Hospital East Sichuan Hospital & Dazhou First People\u2019s Hospital","place":["Dazhou, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qun","family":"Sun","sequence":"additional","affiliation":[{"name":"Chengdu Institute of Food Inspection; Irradiation Preservation Key Laboratory of Sichuan Province","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minhong","family":"Cai","sequence":"additional","affiliation":[{"name":"Healthcare-associated Infection Control Center, Sichuan Academy of Medical Sciences, Sichuan Provincial People\u2019s Hospital, School of Medicine, University of Electronic Science and Technology of China","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Chen","sequence":"additional","affiliation":[{"name":"Healthcare-associated Infection Control Center, Sichuan Academy of Medical Sciences, Sichuan Provincial People\u2019s Hospital, School of Medicine, University of Electronic Science and Technology of China","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pingping","family":"Wang","sequence":"additional","affiliation":[{"name":"Healthcare-associated Infection Control Center, Sichuan Academy of Medical Sciences, Sichuan Provincial People\u2019s Hospital, School of Medicine, University of Electronic Science and Technology of China","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yajun","family":"Bai","sequence":"additional","affiliation":[{"name":"Department of Healthcare-associated Infection Management, Beijing Anzhen Nanchong Hospital of Capital Medical University & Nanchong Central Hospital","place":["Nanchong, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Xiang","sequence":"additional","affiliation":[{"name":"Healthcare-associated Infection Control Center, Sichuan Academy of Medical Sciences, Sichuan Provincial People\u2019s Hospital, School of Medicine, University of Electronic Science and Technology of China","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e172","DOI":"10.1097\/AOG.0000000000002670","article-title":"Practice Bulletin No. 195: Prevention of infection after gynecologic procedures","volume":"131","year":"2018","journal-title":"Obstet. Gynecol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1007\/s40520-014-0270-7","article-title":"Gynecologic surgery in the elderly population: an increasing trend over two decades","volume":"27","author":"Abdullah Agha","year":"2015","journal-title":"Aging Clin. Exp. Res."},{"key":"B3","doi-asserted-by":"publisher","first-page":"839","DOI":"10.1001\/jama.1981.03310330029019","article-title":"Preparation of the vagina for surgery. A comparison of povidone-iodine and saline solution","volume":"245","author":"Amstey","year":"1981","journal-title":"JAMA"},{"key":"B4","first-page":"16","article-title":"Effectiveness of vaginal douching on febrile and infectious morbidities after total abdominal hysterectomy: a multicenter randomized controlled trial","volume":"87","author":"Buppasiri","year":"2004","journal-title":"J. Med. Assoc. Thai"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1791","DOI":"10.1007\/s00404-023-07199-y","article-title":"Does vaginal cleansing with iodine decrease infection rate in office hysteroscopy","volume":"308","author":"Cohen","year":"2023","journal-title":"Arch. Gynecol Obstet."},{"key":"B6","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1097\/SLA.0000000000002208","article-title":"Clinical predictors of positive postoperative blood cultures","volume":"267","author":"Copeland-Halperin","year":"2018","journal-title":"Ann. Surg."},{"key":"B7","doi-asserted-by":"publisher","first-page":"422","DOI":"10.1016\/j.ajog.2004.08.010","article-title":"A randomized trial that compared povidone iodine and chlorhexidine as antiseptics for vaginal hysterectomy","volume":"192","author":"Culligan","year":"2005","journal-title":"Am. J. Obstet. Gynecol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1016\/j.ajic.2023.08.012","article-title":"Impact of converting from povidone iodine to chlorhexidine gluconate for vaginal preparation prior to hysterectomy","volume":"52","author":"Duong","year":"2024","journal-title":"Am. J. Infect. Control"},{"key":"B9","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1186\/s12879-025-12461-6","article-title":"Incidence of postoperative fever and bloodstream infections in gynecological surgical patients: a three-year retrospective surveillance","volume":"26","author":"Gong","year":"2025","journal-title":"BMC Infect. Dis."},{"key":"B10","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1097\/AOG.0000000000003637","article-title":"Hysterectomy route and numbers reported by graduating residents in obstetrics and gynecology training programs","volume":"135","author":"Gressel","year":"2020","journal-title":"Obstet. Gynecol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/j.ajog.2015.02.019","article-title":"Global epidemiology of hysterectomy: possible impact on gynecological cancer rates","volume":"213","author":"Hammer","year":"2015","journal-title":"Am. J. Obstet. Gynecol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1097\/SPV.0000000000001066","article-title":"Chlorhexidine versus iodine for vaginal preparation before hysterectomy: a randomized clinical trial","volume":"28","author":"Hill","year":"2022","journal-title":"Female Pelvic Med. Reconstr. Surg."},{"key":"B13","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1080\/00016340902795345","article-title":"The influence of preoperative vaginal cleansing on postoperative infectious morbidity in abdominal total hysterectomy for benign indications","volume":"88","author":"Kj\u00f8lhede","year":"2009","journal-title":"Acta Obstet. Gynecol Scand."},{"key":"B14","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1111\/j.1600-0412.2010.01023.x","article-title":"Vaginal cleansing and postoperative infectious morbidity in vaginal hysterectomy. A register study from the Swedish National Register for Gynecological Surgery","volume":"90","author":"Kj\u00f8lhede","year":"2011","journal-title":"Acta Obstet. Gynecol Scand."},{"key":"B15","article-title":"Diagnostic criteria for nosocomial infections (trial implementation)","volume-title":"Ministry of Health","year":"2001"},{"key":"B16","volume-title":"Guidelines for clinical application of antibacterial drugs (2015 edition)","year":"2015"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.12659\/MSM.938776","article-title":"Assessment of hospital volume in the surgical management of endometrial and ovarian cancer: a Polish population-based study","volume":"29","author":"Pi\u0105tek","year":"2023","journal-title":"Med. Sci. Monit."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1241","DOI":"10.1001\/jama.2017.13836","article-title":"Incidence and trends of sepsis in US hospitals using clinical vs claims data 2009-2014","volume":"318","author":"Rhee","year":"2017","journal-title":"JAMA"},{"key":"B19","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1017\/ice.2015.264","article-title":"Objective sepsis surveillance using electronic clinical data","volume":"37","author":"Rhee","year":"2016","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"560.e1","DOI":"10.1016\/j.ajog.2021.08.035","article-title":"Vaginal preparation with povidone-iodine or chlorhexidine before hysterectomy: a propensity score matched analysis","volume":"225","author":"Skeith","year":"2021","journal-title":"Am. J. Obstet. Gynecol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1016\/j.jmig.2020.08.006","article-title":"Enhanced recovery and surgical optimization protocol for minimally invasive gynecologic surgery: an AAGL white paper","volume":"28","author":"Stone","year":"2021","journal-title":"J. Minim. Invasive Gynecol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1270","DOI":"10.1016\/j.jiac.2021.04.019","article-title":"Rate of blood culture submissions in Japan as an indicator of bloodstream infections","volume":"27","author":"Tajima","year":"2021","journal-title":"J. Infect. Chemother."},{"key":"B23","doi-asserted-by":"publisher","first-page":"622","DOI":"10.19538\/j.fk2022060112","article-title":"Chinese expert consensus on preoperative assessment and preparation for gynecologic surgery, (2022 edition)","volume":"38","author":"Xu","year":"2022","journal-title":"Chin. J. Pract. Gynecology Obstetrics"}],"container-title":["Frontiers in Cellular and Infection Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2026.1847878\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T04:15:33Z","timestamp":1787199333000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2026.1847878\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,20]]},"references-count":23,"alternative-id":["10.3389\/fcimb.2026.1847878"],"URL":"https:\/\/doi.org\/10.3389\/fcimb.2026.1847878","relation":{},"ISSN":["2235-2988"],"issn-type":[{"value":"2235-2988","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,20]]},"article-number":"1847878"}}