Risk factors for urinary tract infection following incontinence surgery

Nygaard, Ingrid; Brubaker, Linda; Chai, Toby C.; Markland, Alayne D.; Menefee, Shawn A.; Sirls, Larry; Sutkin, Gary; Arisco, Amy; Huang, Liyuan; Tennstedt, Sharon L.; Stoddard, Anne M.

doi:10.1007/s00192-011-1429-9

Cited by 72 publications

(45 citation statements)

References 18 publications

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“…This analysis found that a history of recurrent UTIs preoperatively was the strongest risk factor for postoperative UTI [8]. Our study confirmed a similar association between a history of recurrent UTIs and preoperative UTI.…”

Section: Discussionsupporting

confidence: 89%

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Predictors of positive preoperative urine cultures in asymptomatic women undergoing urogynecologic surgery

Polin¹,

Edenfield²,

Dieter³

et al. 2015

Clin Obstet Gynecol Reprod Med

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Aim: To identify risk factors for positive preoperative urine cultures in asymptomatic women undergoing urogynecologic surgery. We also sought to identify risk factors for mixed flora clean catch urine cultures.Methods: This is a cross-sectional study. Demographic data and screening preoperative urine cultures were extracted on all women who underwent urogynecologic surgery between 9/2011 and 9/2013. Urine culture results were defined as: negative (no growth), positive (≥100K organisms), and contaminated (mixed flora). Women with <100K colony-forming units of a single organism were excluded. Logistic regression models were constructed to evaluate for differences between groups.Results: 490 women were included. When comparing positive to negative cultures, the positive culture group was more likely to have a history of recurrent urinary tract infections (UTIs) (20% vs. 5%, p=0.001). In a logistic regression model,a history of recurrent UTIs remained a risk factor for a positive preoperative urine culture (OR 6.9, 95% CI 2.3-20.8), whereas vaginal estrogen usage decreased the risk of a positive preoperative culture (OR 0.3, 95% CI 0.1-0.9). When comparing contaminated to negative cultures, the contaminated culture group was more likely to be obese (45% vs. 28%, p=0.001). In a logistic regression model, obesity remained a risk factor for contaminated preoperative urine cultures (OR 2.0, 95% CI 1.3-3.2). Conclusion:A history of recurrent UTIs was a risk factor for a positive preoperative urine culture in asymptomatic women undergoing urogynecologic surgery. Vaginal estrogen therapy was associated with fewer positive preoperative urine cultures. Obesity was an independent risk factor for contaminated (mixed flora) clean catch urine culture results.

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Section: Discussionsupporting

confidence: 89%

“…Urinary tract infections (UTIs) are the second most common infection in older women, representing 25% of all clinically diagnosed infections in the US [4]. It is one of the most commonly reported complications of pelvic reconstructive surgery with an estimated incidence as high as 24% [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Predictors of positive preoperative urine cultures in asymptomatic women undergoing urogynecologic surgery

Polin¹,

Edenfield²,

Dieter³

et al. 2015

Clin Obstet Gynecol Reprod Med

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“…30,33,34 In our population, the use of D10 was associated with a 22% increase in UTI with a number needed to harm of 4.5 (absolute rate in D10 group of 47.8%). Patients whose cystoscopy was performed with D10 had a 3.4 times greater odds of being treated for a UTI in the 6 weeks following surgery, even after adjusting for a history of prolonged postoperative catheterization and preoperative recurrent UTI, which are among the most modifiable risk factors of postoperative UTI in patients undergoing urogynecological procedures.…”

Section: Commentmentioning

confidence: 74%

“…Patients whose cystoscopy was performed with D10 had a 3.4 times greater odds of being treated for a UTI in the 6 weeks following surgery, even after adjusting for a history of prolonged postoperative catheterization and preoperative recurrent UTI, which are among the most modifiable risk factors of postoperative UTI in patients undergoing urogynecological procedures. 34 This is a substantial increase and clinically relevant.…”

Section: Commentmentioning

confidence: 98%

Assessing ureteral patency using 10% dextrose cystoscopy fluid: evaluation of urinary tract infection rates

Siff

Unger

Jelovsek

et al. 2016

American Journal of Obstetrics and Gynecology

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BACKGROUND: Intravenous indigo carmine has routinely been used to confirm ureteral patency after urogynecologic surgery. Recent discontinuation of the dye has altered clinical practice. In the absence of indigo carmine, we have used 10% dextrose in sterile water (D10) as cystoscopic fluid to evaluate ureteral patency. Glucosuria has been associated with urinary tract infection (UTI) in vivo and significantly enhanced bacterial growth in vitro. The concern is that the use of D10 would mimic a state of glucosuria albeit transient and increase the risk of postoperative UTI. OBJECTIVES: The objectives of this study were to compare the rates of postoperative UTI and lower urinary tract (LUT) injuries between patients who underwent instillation of D10 vs normal saline at the time of intraoperative cystoscopy after urogynecological surgery. STUDY DESIGN: This was a retrospective cohort study of all women who underwent cystoscopic evaluation of ureteral patency at the time of urogynecological surgery from May through December 2014 at a tertiary care referral center. We compared patients who received D10 cystoscopy fluid vs those who used normal saline. Outcomes included UTI and diagnosis of ureteral or LUT injuries. UTI was diagnosed according to Centers for Disease Control and Prevention guidelines by symptoms alone, urine dipstick, urinalysis, or urine culture. Descriptive statistics compared

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“…The higher rate of UTIs in the mesh group was likely associated with the higher rates of retention and associated catheterizations, both known to predispose patients to UTIs. [25][26][27] Mesh placement was associated with higher rates of UTIs, regardless of concomitant sling placement. A UTI diagnosis appearing in a Medicare claim may or may not be culture-proven.…”

Section: Commentmentioning

confidence: 96%

1544 Short-Term Outcomes of Vaginal Mesh Placement Among Female Medicare Beneficiaries

Anger¹,

Khan²,

Eilber³

et al. 2012

Journal of Urology

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Objectives-To compare short-term outcomes between prolapse repairs with and without mesh using a national dataset. Mesh use in surgical treatment of pelvic organ prolapse (POP) has gained wide popularity. However, mesh complications have increased concomitantly with its use. Methods-PublicUse File data were obtained for a 5% random national sample of female Medicare beneficiaries age 65 and over. Women who underwent prolapse surgery were identified by CPT-4 codes. Since the code for mesh placement was effected in 2005, we separated patients into three cohorts: those who underwent prolapse repairs from 1999-2000 (presumably without mesh), those who underwent repairs in 2007-2008 (presumably without mesh), and those with mesh (based on CPT-4 code 57267) in [2007][2008]. One-year outcomes were identified using ICD-9 diagnosis and procedure codes and CPT-4 procedure codes. Results DisclosuresKaryn S. Eilber is a speaker for Astellas; an investigator and consultant for American Medical Systems; and an investigator for Boston Scientific. J. Quentin Clemens is a consultant for Medtronic, Afferent Pharmaceuticals, and Amphora Medical; a speaker for Endo Pharmaceuticals; involved in trial participation with Taris; and a meeting participant with Allergen. All other authors report no conflicts of interest.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. vs. 4%, p < 0.02). Mesh removal rates were higher in mesh vs. non-mesh group (4% vs. 0-1%, p < 0.001). Mesh use was associated with more dyspareunia, mesh-related complications, and urinary retention, even when controlling for concomitant sling. NIH Public AccessConclusions-Mesh to treat POP and stress urinary incontinence (SUI) was associated with a small decrease in early re-operation for prolapse. This decrease came at the expense of increased rates of pelvic pain, retention, mesh-related complications, and mesh removal.

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Risk factors for urinary tract infection following incontinence surgery

Cited by 72 publications

References 18 publications

Predictors of positive preoperative urine cultures in asymptomatic women undergoing urogynecologic surgery

Predictors of positive preoperative urine cultures in asymptomatic women undergoing urogynecologic surgery

Assessing ureteral patency using 10% dextrose cystoscopy fluid: evaluation of urinary tract infection rates

1544 Short-Term Outcomes of Vaginal Mesh Placement Among Female Medicare Beneficiaries

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