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Perioperative Antibiotic Choice and Urinary Tract Infections in Prolapse Surgery
Margot Le Neveu1,2, Charlie Toman3, Stephen Rhodes1
1Urology Institute, University Hospitals/Cleveland Medical Center.
Insights
Cefazolin-based antibiotics reduce urinary tract infection (UTI) complications after pelvic organ prolapse (POP) surgery compared to gentamicin plus clindamycin (GC). This finding aids in selecting optimal perioperative antibiotic regimens for POP patients to prevent post-surgical UTIs.
Area of Science:
- Urology
- Infectious Diseases
- Surgical Outcomes
Background:
- Urinary tract infections (UTIs) are frequent and preventable complications following pelvic organ prolapse (POP) surgery.
- Optimal perioperative antibiotic selection is crucial for minimizing postoperative complications in POP patients.
Purpose of the Study:
- To compare hospital-based postoperative UTI rates in patients undergoing POP surgery based on the perioperative antibiotic regimen received.
- To evaluate the efficacy of cefazolin (C), gentamicin + clindamycin (GC), and cefazolin + metronidazole (CM) regimens in preventing UTIs.
Main Methods:
- Retrospective cohort analysis of 166,673 patients undergoing POP surgery from 2000 to 2022.
- Primary outcome: UTIs within 30 days postoperatively. Secondary outcomes: emergency department visits, inpatient admissions, and UTIs within 90 days.
- Inverse probability of treatment weighting (IPTW) used to control for confounding preoperative factors.
Main Results:
- The overall 30-day postoperative UTI rate was 3.0%.
- The gentamicin + clindamycin (GC) regimen was associated with significantly higher rates of 90-day UTIs, UTI-related ED visits, and hospitalizations compared to cefazolin-based regimens.
- After IPTW, GC remained linked to increased odds of 30-day UTIs (OR, 1.27), 90-day UTIs (OR, 1.30), UTI-related ED visits (OR, 1.40), and inpatient admissions (OR, 1.36).
Conclusions:
- Cefazolin-based antibiotic regimens are associated with a lower probability of hospital-based UTI-related complications after POP surgery compared to the gentamicin + clindamycin regimen.
- These findings support the use of cefazolin-based antibiotics for preventing UTIs in patients undergoing POP surgery.
Importance:
Urinary tract infections (UTIs) are common yet preventable complications after pelvic organ prolapse (POP) surgery.
Objective:
The objective of this study was to compare hospital-based postoperative UTI rates among patients undergoing POP surgery by perioperative antibiotic regimen received: cefazolin (C), gentamicin + clindamycin (GC), or cefazolin + metronidazole (CM).
Study Design:
This was a retrospective cohort analysis of patients undergoing POP surgery from 2000 to 2022 using a U.S. national database. The primary outcome was UTIs within 30 days postoperatively. Secondary outcomes included emergency department (ED) visits, inpatient admissions, and UTIs within 90 days postoperatively. Inverse probability of treatment weighting (IPTW) was performed to balance on potential confounding preoperative characteristics.
Results:
Of 166,673 POP surgery patients, 3.0% (n=4,953) were diagnosed with a 30-day postoperative UTI. The UTI rate differed by perioperative antibiotic regimen: C 2.9% (n=4,197), CM 2.5% (n=295), and GC 3.8% (n=461), P <0.001. GC was associated with a higher 90-day UTI rate (4.9%, n=601, P <0.001), UTI-related ED visits (1.8%, n=219, P <0.001), and UTI-related hospitalization (0.73%, n=89, P =0.0014) compared with cefazolin-based antibiotic cohorts. After IPTW, cefazolin-based regimens remained associated with decreased odds of postoperative UTI-related complications compared with GC. Compared with cefazolin, GC was associated with increased odds of 30-day UTIs (OR, 1.27; 95% CI, 1.14-1.42), 90-day UTIs (OR, 1.30; 95% CI, 1.18-1.43), UTI-related ED visits (OR, 1.40; 95% CI, 1.19-1.63), and UTI-related inpatient admissions (OR, 1.36; 95% CI, 1.06-1.74).
Conclusions:
Among patients undergoing POP surgery, cefazolin-based antibiotic regimens were associated with a lower probability of hospital-based UTI-related complications compared with the group receiving GC.
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