Antibiotic Prophylaxis for Urinary Tract Infection After Midurethral Sling

Jackson, Daniel L.; Higgins, Edmund; Bracken, Jessica; Yandell, Paul M.; Shull, B C; Foster, Raymond T.

doi:10.1097/spv.0b013e318285ba53

Cited by 31 publications

(28 citation statements)

References 21 publications

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“…Anger et al 31 reported an absolute UTI rate of 34% in the 3 months following a sling procedure, Jackson et al 32 reported a UTI rate of 32% in women undergoing outpatient sling procedures (with or without outpatient pelvic reconstructive procedures) who were not treated with postoperative prophylactic antibiotics.…”

Section: Resultsmentioning

confidence: 99%

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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Section: Resultsmentioning

confidence: 99%

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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“…4 In the field of obstetrics and gynecology, UTI is one of the most common complications of pelvic reconstructive surgery, as is urinary retention. 5,[7][8][9][10][11][12][13][14][15] Urinary retention occurs in up to 50% of women undergoing pelvic floor surgery. 5,[7][8][9][10][11][12][13][14][15] Urinary retention occurs in up to 50% of women undergoing pelvic floor surgery.…”

Section: Resultsmentioning

confidence: 99%

Oral Antibiotics to Prevent Postoperative Urinary Tract Infection

Dieter

Amundsen

Edenfield

et al. 2014

Obstetrics &Amp; Gynecology

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“…Four studies included women who had vaginal surgery concomitantly with MUS. Harmanli et al, Ghezzi et al, and Swartz et al examined women with MUS alone.…”

Section: Resultsmentioning

confidence: 99%

“…Harmanli et al, Ghezzi et al, and Swartz et al examined women with MUS alone. Among studies of women with vaginal surgery concomitant with MUS, Dieter et al, Hampton et al, and Jackson et al analyzed UTI post‐MUS as a separate group; however, the studies were not powered to analyze differences in the primary outcome stratified by surgery type. Five studies included both retropubic and transobturator MUS .…”

Section: Resultsmentioning

confidence: 99%

“…One study routinely used a postoperative transurethral catheter and another, a suprapubic catheter in all women . One study included women who were sent home with or without need for postoperative catheterization; another specifically excluded women with postoperative urinary retention needing catheterization . Postoperatively, oral nitrofurantoin, oral prulifloxacin or a variety of oral antibiotics based on provider preference were used.…”

Section: Resultsmentioning

confidence: 99%

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Urinary tract infection prevention after midurethral slings in pelvic floor reconstructive surgery: A systematic review and meta‐analysis

Sanaee

Hutcheon

Larouche

et al. 2019

Acta Obstet Gynecol Scand

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Introduction Synthetic midurethral slings are the most common procedures currently performed for stress urinary incontinence in women. Infection is a frequent complication of urogynecologic surgery. We performed a systematic review and meta‐analysis to identify interventions that successfully prevent infections, including urinary tract infection (UTI) and/or bacteriuria, compared with no intervention, in women undergoing midurethral sling surgery with or without concomitant pelvic reconstructive procedures for prolapse. Material and methods The primary outcome was the development of any infection post‐midurethral sling placement in women. MEDLINE, Embase, CINAHL and the Cochrane Library were searched for comparative studies from inception to July 2017, with no language restrictions. We used search terms related to midurethral sling, infections and infection‐reduction interventions. Two independent reviewers abstracted data and assessed study quality. Pooled effect size estimates were calculated. We conducted meta‐analysis of eligible studies. A protocol for this review has been registered and can be accessed online (http://hdl.handle.net/2429/64731). Results We identified seven eligible studies of infection risk‐reducing interventions; all focused on UTIs. Only one study assessed preoperative antibiotics with midurethral sling alone and was halted early because of low UTI rates. All other studies (three randomized control trials and three observational studies) examined whether postoperative antibiotics decrease UTI/bacteriuria rates after midurethral sling with or without reconstructive procedures for pelvic organ prolapse and using bladder catheterization postoperatively. Due to considerable clinical heterogeneity, we only combined four studies for meta‐analysis. Postoperative oral prophylactic nitrofurantoin showed no significant benefit in reducing UTI/bacteriuria in women post‐midurethral sling with or without concomitant reconstructive pelvic surgery and the need for bladder catheterization, when compared with the reference group (pooled relative risk 0.73, 95% confidence interval [CI] 0.42‐1.25). Conclusions Based on the best available evidence, postoperative oral nitrofurantoin is not effective at reducing UTI/bacteriuria rates in catheterized women after midurethral sling with or without concomitant pelvic reconstructive surgery for prolapse. For midurethral sling alone, preoperative antibiotic prophylaxis may not be needed for UTI prevention.

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Antibiotic Prophylaxis for Urinary Tract Infection After Midurethral Sling

Abstract: A short (3-day) course of nitrofurantoin after outpatient sling surgery significantly reduces the incidence of postoperative bladder infection in the first 6 weeks after sling surgery.

Cited by 31 publications

References 21 publications

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

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

Oral Antibiotics to Prevent Postoperative Urinary Tract Infection

Urinary tract infection prevention after midurethral slings in pelvic floor reconstructive surgery: A systematic review and meta‐analysis

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