Risk of Urinary Tract Infection After Hysterectomy for Benign Indications Based on Antibiotic Prophylaxis Regimen

To assess the rate of postoperative urinary tract infection (UTI) after hysterectomy based on antibiotic prophylaxis regimen.

Retrospective cohort study SETTING: Premier Healthcare Database PARTICIPANTS: A total of 220,499 patients undergoing hysterectomy for benign indications between January 2000 and December 2022 were included. Patients were excluded if they received any antibiotic regimen other than the prespecified prophylaxis groupings, no antibiotic prophylaxis was documented or if a prolapse or anti-incontinence procedure was performed.

Patients were grouped by those who received cefazolin, cefazolin + metronidazole, or gentamicin + clindamycin for perioperative antibiotic prophylaxis.

Of the included patients, 84.6% received cefazolin alone, 8.2% received cefazolin + metronidazole and 7.2% received gentamicin + clindamycin. The overall rate of postoperative UTI was 3.2%. After performing inverse probability of treatment weighted analysis based on preoperative and operative characteristics, the hazard ratio for developing a postoperative UTI suggests an increased risk for those receiving gentamicin + clindamycin compared to those receiving cefazolin (HR 1.36, 95% CI [1.26-1.47]) or cefazolin + metronidazole (HR 1.34, 95% CI [1.20-1.50]). The HR for those receiving cefazolin compared with cefazolin + metronidazole was not significantly different from 1 (HR 1.02, 95% CI [0.93-1.11]). Cumulative incidence, after weighting, demonstrated that those who received gentamicin + clindamycin were more likely to have a readmission or emergency department visit for a UTI related diagnosis within three months after surgery than those who received cefazolin or cefazolin + metronidazole.

Patients who receive gentamicin + clindamycin at the time of hysterectomy for benign indications are more likely to experience a postoperative UTI than those who receive cefazolin or cefazolin + metronidazole.