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. 2022 Nov 1;28(11):763-769.
doi: 10.1097/SPV.0000000000001242. Epub 2022 Aug 31.

Reduction in Rates of Symptomatic Urinary Tract Infection After Pelvic Reconstructive Surgery: A Quality Improvement Analysis

Mary Duarte Thibault  1 , Allison Milen  2 , Luke Burns  1 , Anca Tilea  1 , Kenneth Piehl  1 , Daniel Morgan  1
Affiliations

Reduction in Rates of Symptomatic Urinary Tract Infection After Pelvic Reconstructive Surgery: A Quality Improvement Analysis

Mary Duarte Thibault et al. Urogynecology (Phila). .

Abstract

Importance: Urinary tract infections contribute to high health care costs.

Objective: This study aimed to determine if a combination of interventions was successful at reducing the rate of postoperative symptomatic urinary tract infections (SUTIs) in a female pelvic medicine and reconstructive surgery (FPMRS) practice.

Study design: Observational, retrospective quality improvement analysis looking at the rate of postoperative SUTI within 30 days of surgery in women who underwent gynecologic surgery performed by an FPMRS surgeon from October 2015 to October 2019. Symptomatic urinary tract infection was defined by symptoms and urinalysis, positive urine culture, or treatment for cystitis or urethritis within 30 days of surgery. Interventions were implemented between 2015 and 2016: perioperative cranberry use, intraoperative protocols for catheterization, and postoperative protocols for urinary retention management. In 2018, we added metronidazole to cefazolin for antibiotic prophylaxis. We developed a multivariable logistic regression to determine if postoperative SUTI rates decreased over the study period with adjustment for clustering by surgeons, patient factors, and surgery type.

Results: Of 2,389 procedures performed, 284 (11.8%) involved patients who had an SUTI within 30 days of surgery. The annual infection rate decreased 50% (year 1, 14.7%; year 4, 7.3%). Adjusting for age, race, body mass index, length of stay, surgery type, and surgeon, the odds of SUTI decreased 19% each year (odds ratio [OR], 0.81; 95% confidence interval [CI], 0.72-0.91; P < 0.001). Compared with women who had other gynecologic procedures, those who underwent vaginal prolapse surgery with or without incontinence procedures (OR, 2.75; 95% CI, 1.35-5.54; P = 0.01) or incontinence surgery alone (OR, 2.65; 95% CI, 1.25-5.62; P = 0.01) were more likely to have an SUTI.

Conclusion: Combining interventions can be highly effective in reducing postoperative SUTI rates.

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Conflict of interest statement

The authors have declared they have no conflicts of interest.

References

    1. Shuman EK, Chenoweth CE. Urinary catheter-associated infections. Infect Dis Clin North Am 2018;32(4):885–897. doi:10.1016/j.idc.2018.07.002. - DOI
    1. Hollenbeak CS, Schilling AL. The attributable cost of catheter-associated urinary tract infections in the United States: a systematic review. Am J Infect Control 2018;46(7):751–757. doi:10.1016/j.ajic.2018.01.015. - DOI
    1. Lake AG, McPencow AM, Dick-Biascoechea MA, et al. Surgical site infection after hysterectomy. Am J Obstet Gynecol 2013;209(5):490.e1–490.e9. doi:10.1016/j.ajog.2013.06.018. - DOI
    1. Chung CP, Kuehl TJ, Harris SK, et al. Incidence and risk factors of postoperative urinary tract infection after uterosacral ligament suspension. Int Urogynecol J 2012;23(7):947–950. doi:10.1007/s00192-012-1709-z. - DOI
    1. Albo ME, Richter HE, Brubaker L, et al. Burch colposuspension versus fascial sling to reduce urinary stress incontinence. N Engl J Med 2007;356(21):2143–2155. doi:10.1056/NEJMoa070416. - DOI

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