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. 2024 Mar 4;7(3):e240900.
doi: 10.1001/jamanetworkopen.2024.0900.

Propensity Score-Weighted Analysis of Postoperative Infection in Patients With and Without Preoperative Urine Culture

William J O'Brien  1 , Marin L Schweizer  2   3 , Judith Strymish  4 , Brice F Beck  5 , Vanessa Au  5 , Jeffrey A Chan  1 , Madisen Brown  1 , Kamal M F Itani  6 , Kimberly C Dukes  5   7 , Julia Friberg Walhof  5 , Kalpana Gupta  1   4
Affiliations

Propensity Score-Weighted Analysis of Postoperative Infection in Patients With and Without Preoperative Urine Culture

William J O'Brien et al. JAMA Netw Open. .

Abstract

Importance: Although recent guidelines recommend against performance of preoperative urine culture before nongenitourinary surgery, many clinicians still order preoperative urine cultures and prescribe antibiotics for treatment of asymptomatic bacteriuria in an effort to reduce infection risk.

Objective: To assess the association between preoperative urine culture testing and postoperative urinary tract infection (UTI) or surgical site infection (SSI), independent of baseline patient characteristics or type of surgery.

Design, setting, and participants: This cohort study analyzed surgical procedures performed from January 1, 2017, to December 31, 2019, at any of 112 US Department of Veterans Affairs (VA) medical centers. The cohort comprised VA enrollees who underwent major elective noncardiac, nonurological operations. Machine learning and inverse probability of treatment weighting (IPTW) were used to balance the characteristics between those who did and did not undergo a urine culture. Data analyses were performed between January 2023 and January 2024.

Exposures: Performance of urine culture within 30 days prior to surgery.

Main outcomes and measures: The 2 main outcomes were UTI and SSI occurring within 30 days after surgery. Weighted logistic regression was used to estimate odds ratios (ORs) for postoperative infection based on treatment status.

Results: A total of 250 389 VA enrollees who underwent 288 858 surgical procedures were included, with 88.9% (256 753) of surgical procedures received by males and 48.9% (141 340) received by patients 65 years or older. Baseline characteristics were well balanced among treatment groups after applying IPTW weights. Preoperative urine culture was performed for 10.5% of surgical procedures (30 384 of 288 858). The IPTW analysis found that preoperative urine culture was not associated with SSI (adjusted OR [AOR], 0.99; 95% CI, 0.90-1.10) or postoperative UTI (AOR, 1.18; 95% CI, 0.98-1.40). In analyses limited to orthopedic surgery and neurosurgery as a proxy for prosthetic implants, the adjusted risks for UTI and SSI were also not associated with preoperative urine culture performance.

Conclusions and relevance: This cohort study found no association between performance of a preoperative urine culture and lower risk of postoperative UTI or SSI. The results support the deimplementation of urine cultures and associated antibiotic treatment prior to surgery, even when using prosthetic implants.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Schweizer reported receiving grants from 3M outside the submitted work. Dr Dukes reported receiving grants from Veterans Affairs (VA) Health Services Research & Development during the conduct of the study. Dr Gupta reported receiving grants from VA Health Services Research & Development during the conduct of the study; receiving personal fees from GSK, Utility Therapeutics, Iterum Therapeutics, Qiagen Diagnostics, and Spero Therapeutics outside the submitted work; and being an uncompensated coauthor on Infectious Diseases Society of America guidelines on asymptomatic bacteriuria. No other disclosures were reported.

Figures

Figure.
Figure.. Flow Diagram of Study Population
UTI indicates urinary tract infection; VA, US Department of Veterans Affairs.
See this image and copyright information in PMC

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