Is antibiotic prophylaxis necessary in mid-urethral sling surgery?

Abstract

Introduction and hypothesis Antibiotic prophylaxis is commonly used when implanting a mid-urethral sling (MUS) for female stress urinary incontinence. Use of antibiotics may lead to adverse events and the development of antibiotic resistance. This study compared a variety of outcomes after MUS surgery with and without antibiotic prophylaxis using data from the national Norwegian Female Incontinence Registry. Methods Preoperative and 6–12 months postoperative subjective and objective data from 28,687 patients who received MUS surgery from 1998 through 2017 were extracted from the registry. Categorical outcomes were compared between women with or without antibiotic prophylaxis using chi-square test for independence. Primary outcome was incidence of postoperative surgical site infection (SSI). Secondary outcomes were incidence of tape exposure, de novo or persistent urgency urinary incontinence, postoperative pain > 3 months, subjective and objective cure rates, and patient satisfaction. Results Antibiotic prophylaxis was used in 9131 and not used in 19,556 patients. SSIs and prolonged postoperative pain occurred significantly more often without antibiotic prophylaxis. Subjective and objective cure rates were significantly higher and tape exposures significantly lower in women not receiving prophylactic antibiotics. There were no significant differences in other outcomes. Conclusions Antibiotic prophylaxis resulted in fewer women developing postoperative infections or prolonged postoperative pain after MUS surgery, but did not offer protection against tape exposure. The differences in cure rates were small and probably without clinical relevance. If a small increase in surgical site infections is accepted, the routine use of antibiotic prophylaxis can probably be omitted.

AUGS-IUGA Joint Clinical Consensus Statement on Enhanced Recovery After Urogynecologic Surgery

“…No RCT has been conducted comparing use of vaginal mesh for prolapse surgery with or without antibiotics, or for sacrocolpopexy. A national Norwegian registry study on midurethral slings concluded that antibiotic prophylaxis reduced postoperative infections and pain, but not tape exposure 43 …”

“…A national Norwegian registry study on midurethral slings concluded that antibiotic prophylaxis reduced postoperative infections and pain, but not tape exposure. 43 Showering or bathing with soap or antiseptic solution to reduce the bacteria count on the skin has been studied. A Cochrane review showed no difference between preoperative skin washing with chlorhexidine solution versus usual soap or placebo, but it demonstrated efficacy of showering with some cleansing method versus no showering.…”

Antibiotic prophylaxis in urologic interventions: Who, when, where?

“…A registry-based cohort study 104 of 28,687 women undergoing midurethral sling implantation showed that AP led to a reduction in the occurrence of postoperative infections and extended pain after surgery but did not offer protection against tape exposure. However, the variations in the success rate were minimal and likely not significant from a clinical perspective.…”