Wu Emily, Kuehl Thomas J, Danford Jill M, Bird Erin T, Yandell Paul M
Division of Urogynecology, University of Massachusetts Memorial Medical Center, Worcester, MA, USA.
Department of Obstetrics and Gynecology, Baylor Scott and White Medical Center, Temple, TX, USA.
Int Urogynecol J. 2022 Apr;33(4):897-902. doi: 10.1007/s00192-021-04916-6. Epub 2021 Jul 15.
The primary objective is to measure the difference in urinary tract infection (UTI) rates within 6 weeks of placement of a retropubic mid-urethral sling (RMUS) in the setting of various postoperative prophylactic antibiotic regimens. UTI rates were measured by antibiotic prescriptions to treat UTI and/or culture. Secondary aims included determining risk factors for postoperative UTI.
A retrospective chart review from 2014 to 2016 was performed at Baylor Scott and White Medical Center-Temple for CPT code 57288. Univariate comparisons were performed using chi-square and Student's t-test. Logistic regression analysis was performed for UTI risk factors with univariate p values ≤ 0.1.
One hundred twelve subjects were included. Seventeen (15%) were treated for postoperative UTI. Postoperative prophylactic antibiotics included trimethoprim (39.3%), nitrofurantoin (31.3%), trimethoprim-sulfamethoxazole (5.4%), ciprofloxacin (2.7%), and cephalexin (1.8%). Ninety subjects were prescribed postoperative prophylactic antibiotics (80.4%). The postoperative UTI rate was not significantly different between those who were prescribed postoperative prophylactic antibiotics (16%) and those who were not (14%). None of the treatments showed a significant difference on postoperative UTI rate compared to no treatment. Significant risk factors for UTI included catheterization past postoperative day 1 (OR 6.4, 95% CI 1.7 - 23.8; p = 0.006).
There was no significant difference in postoperative UTI rate in the group without postoperative prophylactic antibiotics compared to those who did receive it. Catheterization past postoperative day 1 was significantly associated with postoperative UTI. However, definitive conclusions are limited by a lack of power.
主要目的是测量在不同术后预防性抗生素治疗方案下，耻骨后尿道中段吊带（RMUS）置入后6周内的尿路感染（UTI）发生率。UTI发生率通过治疗UTI的抗生素处方和/或培养来测量。次要目的包括确定术后UTI的危险因素。
对贝勒斯科特与怀特医疗中心-坦普尔2014年至2016年CPT编码为57288的病例进行回顾性图表审查。使用卡方检验和学生t检验进行单因素比较。对单因素p值≤0.1的UTI危险因素进行逻辑回归分析。
纳入112名受试者。17名（15%）接受了术后UTI治疗。术后预防性抗生素包括甲氧苄啶（39.3%）、呋喃妥因（31.3%）、甲氧苄啶-磺胺甲恶唑（5.4%）、环丙沙星（2.7%）和头孢氨苄（1.8%）。90名受试者接受了术后预防性抗生素治疗（80.4%）。接受术后预防性抗生素治疗的患者（16%）与未接受治疗的患者（14%）术后UTI发生率无显著差异。与未治疗相比，没有一种治疗方法在术后UTI发生率上显示出显著差异。UTI的显著危险因素包括术后第1天之后的导尿（比值比6.4，95%置信区间1.7 - 23.8；p = 0.006）。
与接受术后预防性抗生素治疗的组相比，未接受术后预防性抗生素治疗的组术后UTI发生率无显著差异。术后第1天之后的导尿与术后UTI显著相关。然而，由于样本量不足，确定性结论有限。
