Risk factors for catheter-associated urinary tract infections following radical hysterectomy for cervical cancer

Abstract

Objectives: Radical hysterectomy is the mainstay of treatment for early-stage cervical cancer. Urinary tract dysfunction is one of the most common complications after radical hysterectomy, and prolonged catheterization has previously been defined as a significant risk factor for catheter-associated urinary tract infections (CAUTI). The purpose of this study was to determine the rate of CAUTI after radical hysterectomy for cervical cancer and identify additional risk factors for developing CAUTI in this population. Methods: We reviewed patients who underwent a radical hysterectomy for cervical cancer from 2004-2020 after institutional IRB approval. All patients were identified from our institution's Gynecologic Oncology surgical database. Inclusion criterion was radical hysterectomy for early-stage cervical cancer. Exclusion criteria included inadequate hospital follow-up, insufficient records of catheter use in the electronic medical record, urinary tract injury, and preoperative chemoradiation. CAUTI was defined as an infection diagnosed in a catheterized patient or within 48 hours of catheter removal, with significant bacteriuria (>103 cfu/mL) and symptoms or signs attributable to the urinary tract. Data analysis was performed using comparative analysis and univariate and multivariate logistic regression using Excel, GraphPad, and SPSS. Results: A total of 276 patients were identified. After applying exclusion criteria, 160 patients were included in the data analysis. The distribution of patients across FIGO stage is as follows: IA1 4.5% (n=4), IA2 6.3% (n=10), IB1 75.6% (n=121), IB2 13.8% (n=22), IIA2 1.9% (n=3). The mean length of indwelling catheter use was 9.3 days (range 0-33 days). 28.8% of patients (n=40) had a urinary catheter placement more than 1 time prior to passing a voiding trial. 12.6% of patients (n=20) were diagnosed with CAUTI. Minimally invasive surgery (MIS) was associated with longer catheterizations compared to an open approach (mean 12.8 days vs 6.9 days, p Conclusions: Catheterization over five days significantly increased the risk for CAUTI development after radical hysterectomy for cervical cancer. Smoking history, increased age, and minimally invasive surgical route are independent predictors for CAUTI. Earlier catheter removal should be encouraged in patients with these risk factors.