Is antibiotic prophylaxis necessary in mid-urethral sling surgery?

Area of Science:

• Urology
• Gynecology
• Infectious Disease

Background:

• Antibiotic prophylaxis is standard for mid-urethral sling (MUS) surgery for female stress urinary incontinence.
• Concerns exist regarding adverse events and antibiotic resistance associated with prophylactic antibiotic use.

Purpose of the Study:

• To compare outcomes of MUS surgery with and without antibiotic prophylaxis.
• To evaluate the impact of antibiotic prophylaxis on surgical site infections, pain, cure rates, and tape exposure.

Main Methods:

• Retrospective analysis of 28,687 patients from the Norwegian Female Incontinence Registry (1998-2017).
• Comparison of outcomes between women who received antibiotic prophylaxis (9,131) and those who did not (19,556).
• Statistical analysis using chi-square test for categorical outcomes.

Main Results:

• Fewer surgical site infections (SSIs) and prolonged postoperative pain were observed in the antibiotic prophylaxis group.
• Higher subjective and objective cure rates and lower tape exposure rates were found in the no-antibiotic group.
• No significant differences in other assessed outcomes, including de novo urgency or patient satisfaction.

Conclusions:

• Antibiotic prophylaxis reduced SSIs and prolonged pain but did not impact tape exposure.
• Observed differences in cure rates were minimal and likely not clinically significant.
• Routine antibiotic prophylaxis for MUS surgery may be omitted if a slight increase in SSIs is acceptable.