Abstract
Background and objective: Urinary tract infections (UTIs) are the most common minor complication after operations, mostly due to bladder catheterization that used routinely during operations. This investigation seeks to determine prevalence rate, bacterial features, antibiotic sensitivity and risk factors for urinary tract infection in postoperative patients in tertiary hospitals in Sana’a, Yemen.
 Methods: This prospective analysis included 390 patients undergoing surgery between 2017 and 2018 at Al-Thawra Hospital. The study includes 258 male and 132 female between the ages 5 to 80 years. Clinical and demographic data and factors affecting UTIs were collected in the standard questionnaire, and the sample was obtained after catheter removal; or, in patients with a clinical indication of continuous catheterization, a sample was obtained after the replacement of a new catheter. The samples were cultured, examined for significant possible bacterial pathogens, isolated and identified by standard laboratory techniques, and microbial sensitivity testing was carried out by disc diffusion method. The operative characteristics associated with postoperative UTI were also analysis.
 Results: Postoperative UTI (POUTI) occurred in 144/390 (37%), and the predominant post-operative uropathogen was Escherichia coli (34%), followed by Pseudomonas aeruginosa 1(27%) and Staphylococcus coagulase negative (16.7%). In Gram-negative bacteria, high resistance to ampicillin (95%), nalidixic acid (63%), ceftriaxone (68%) and cotrimoxazole (55%) was recorded, while high sensitivity to amikacin (98%) and ciprofloxacin. (84%), cefotaxime (87%), gentamicin (87%) and imipenem (98%). In Gram-positive bacteria, high resistance to penicillin (90%), erythromycin (85%), and amoxicillin (78%) was recorded, while high sensitivity to aztreonam (94%), augmentin (83%), ciprofloxacin (93%), cefotaxime (86%), gentamicin (85%), Rifampicin (100%) and vancomycin (97%). The following characteristics are independently associated with postoperative UTI: female sex (OR 2.1, 95% CI 1.3–3.2), Rubber PTFE catheter (OR 4.7, 95% CI 1.99–11.4), longer duration of catheterization >10 days (OR 4.4, 95% CI 2.3–8.3), overweight (OR 1.7, 95% CI 1.1–2.9), and emergency surgery (OR 1.9, 95% CI 1.2–3.0).
 Conclusions: POUTI remains an important problem in our hospitals and what complicates the situation is that all the causative microorganisms are MDR with few treatment options; and several risk factors were independently associated with POUTI.
 Peer Review History: 
 Received 14 May 2020; Revised 15 June; Accepted 1 July, Available online 15 July 2020
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 Received file 
 
 Average Peer review marks at initial stage: 6.0/10
 Average Peer review marks at publication stage: 8.0/10
 Reviewer(s) detail:
 Name: Dr. Amany Mohamed Alboghdadly
 Affiliation: Princess Nourah bint abdulrahman university, Riyadh
 E-mail: amalbgadley@pnu.edu.sa
 
 Name: Dr. A.A. Mgbahurike
 Affiliation: University of Port Harcourt, Nigeria
 E-mail: amaka_mgbahurike@yahoo.com
 
 Comments of reviewer(s): 
 
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Highlights
Background and objectiveUrinary tract infections (UTIs) are the most common minor complication after operations, mostly due to bladder catheterization that used routinely during operations
Current study examined bacterial Postoperative UTI (POUTI) rate in postoperative patients at Al-Thawra University Hospital along with testing for common risk factors and common pathogens associated with bacterial post operative UTI
Obtained results are to some extent higher than published rates perhaps because all of the patients enrolled in this study had undergone operations and stayed longer in hospitals and had a number of risk factors that increase the opportunity of the development of bacterial CAUTI17,18
Summary
Urinary tract infections (UTIs) are the most common minor complication after operations, mostly due to bladder catheterization that used routinely during operations This investigation seeks to determine prevalence rate, bacterial features, antibiotic sensitivity and risk factors for urinary tract infection in postoperative patients in tertiary hospitals in Sana’a, Yemen. In Gram-positive bacteria, high resistance to penicillin (90%), erythromycin (85%), and amoxicillin (78%) was recorded, while high sensitivity to aztreonam (94%), augmentin (83%), ciprofloxacin (93%), cefotaxime (86%), gentamicin (85%), Rifampicin (100%) and vancomycin (97%). The following characteristics are independently associated with postoperative UTI: female sex (OR 2.1, 95% CI 1.3–3.2), Rubber PTFE catheter (OR 4.7, 95% CI 1.99–11.4), longer duration of catheterization >10 days (OR 4.4, 95% CI 2.3–8.3), overweight (OR 1.7, 95% CI 1.1–2.9), and emergency surgery (OR 1.9, 95% CI 1.2–3.0).
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