20: Urinary tract infection following midurethral sling

Abstract

Urinary tract infections (UTIs) are common in women following urogenital surgery and are associated with significant individual and societal burdens. Therefore, the need to further understand clinical risk factors and subsequent strategies for prevention is imperative. The purpose of this study is to identify risk factors for post-operative UTIs following midurethral sling (MUS). We also describe the bacterial species responsible for postoperative UTIs in our community and the antibiotics prescribed. This is a retrospective analysis of patients who underwent MUS from 2010-2018 within a FPMRS practice of 2 surgeons. Data was extracted from review of charts and UTIs were documented up to 12 months following MUS. Risk factors evaluated included patient factors (age, BMI, parity, medical comorbidities, urinary incontinence, post void residual (PVR), smoking history, prolapse stage, vaginal estrogen use, menopausal status, recurrent UTI history, sexual activity, pessary use, hormone replacement use, neurogenic bladder), surgical factors (operative time, antibiotic use, estimated blood loss, concomitant reconstructive surgery, bladder perforation) and postoperative factors (duration of voiding dysfunction, sling revision, urinary incontinence resolution, PVR at 6 week visit). Categorical variables were analyzed with the Chi-square test, and continuous variables were analyzed using Student’s t-tests. Statistically significant demographic and perioperative characteristics were studied in the Multiple Regression Analysis. 915 MUS cases were reviewed. 23% of patients developed at least 1 UTI in the 12-month period postoperatively. On a bivariate analysis, statistically significant associations were found between postoperative UTI and patients with higher age, greater BMI, stage 3 prolapse, recurrent UTI history, asymptomatic bacteriuria, and cardiovascular disease. Significant perioperative characteristics included concomitant reconstructive surgery, voiding dysfunction requiring catheterization, continued post-operative urinary incontinence, and elevated PVR. On a multivariate analysis, prior history of recurrent UTI and PVR >100mL at 6 weeks were associated with UTI postoperatively. A history of recurrent UTIs and UTI within the first 6 weeks postoperatively was both independently associated with development of recurrent UTI in the first year following MUS. Escherichia coli was the predominant bacterial species of both recurrent and nonrecurrent UTIs, and macrobid was the most common antibiotic utilized. This study provides additional power and confirmation of risk factors involved with postoperative UTIs following earlier studies of this topic. Local bacterial species and treatment patterns are described.