Healthcare-Associated Infections after Lower Urinary Tract Endoscopic Surgery: Analysis of Risk Factors, Associated Microorganisms and Patterns of Antibiotic Resistance

Abstract

Objectives: To review the incidence of healthcare-associated infections/urinary tract infection (UTI), risk factors, microorganisms isolated and antibiotic resistances in patients who underwent lower urinary tract endoscopic surgery (LUTES) in a tertiary care hospital. Methods: A prospective observational study was carried out including 1,498 patients who undergo LUTES. Patients with and without UTI after surgery were compared. We analysed infection incidence, risk factors, microorganisms isolated and antibiotic resistances. Results: Postoperative UTI incidence was 4.7%. Risk factors found: higher American Society of Anesthesiologists classification (OR 2.82; 95% CI 1.8–4.5; p < 0.00), immunosuppression (OR 2.89; 95% CI 1.2–7.2; p = 0.01), indwelling urinary catheter prior admission (OR 2.6; 95% CI 1.6–4.2; p < 0.00) and postoperative catheterization longer than 2 days (OR 1.74; 95% CI 1.7–4.3; p < 0.00). Transurethral resection of the bladder (TURB) had the highest infection rates (5.5%). Microorganisms isolated were Pseudomonas aeruginosa (23.5%), Escherichia coli (17.6%), Klebsiella pneumoniae and Enterococcus spp (11.8%). Resistance rates for flourquinolones varied between 28 and 80%, and Carbapenem-resistant Enterobacteriaceae rose up 20%. Conclusions: Low percentage of UTI after endoscopic surgery was registered. TURB was the procedure with highest infection rate. Pseudomonas aeruginosa stands out as the most frequently isolated microorganism. Patient comorbidities, previous urinary catheter and postoperative catheter were identified as risk factors.

Multidrug-Resistant Microorganisms Associated with Urinary Tract Infections Following Orthopaedic Patients: A Laboratory-Based Analysis of 5239 Patients

“…Also some strains of Staphylococcus aureus and coagulase-negative staphylococci [18,22]. Thus, the dominance of Enterobacterales Gram-negative bacteria [11,19,23] in presented study is not a cause for concern.…”

Antibiotic prophylaxis in transurethral resection of bladder tumours: study protocol for a systematic review and meta-analysis

“…Moreover, the rising antimicrobial resistance rates today impose a reasonably dosed use of AP and the careful evaluation of risk factors for postoperative UTI [9].…”

“…observational) studies) that investigate risk factors for UTIs (defined as described above) in patients ≥ 18 years (regardless of sex and age) undergoing TURB independent of the AP scheme. Examples of risk factors for UTIs after TURB, which we anticipate to find based on the knowledge from studies on risk factors in lower urinary tract surgeries are health status, duration of catheterization, and duration of operation [9].…”

“…The choice of a weighting method for pooling the results of the studies will account for the rare events setting. This is because the baseline risk for UTI is usually < 5% [9]; therefore, we expect that studies included in the meta-analysis might have a low number of events. Meta-analyses of studies with rare events face challenges that should be tackled using suitable statistical methods and proper effect measure(s) [14].…”

“…Furthermore, while risk factors for postoperative UTI after transurethral surgery in general have been identified (see e.g. [9]), risk factors for UTI specifically after TURB have so far not been put together in a comprehensive way.…”