Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, La Jolla.
Urogynecology (Phila). 2023 Jul 1;29(7):632-640. doi: 10.1097/SPV.0000000000001317. Epub 2022 Dec 27.
Urinary tract infection (UTI) is a common and potentially avoidable postoperative (PO) adverse event after urogynecologic surgery. Understanding pathophysiology will help prevent the associated morbidity of the disease and treatment of PO-UTI.
The objective of this study is to determine the following: (1) risk factors for both PO-UTI and PO recurrent UTI (RUTI) after urogynecologic surgery, (2) temporal distribution of UTI, and (3) uropathogen identification.
Women undergoing urogynecologic surgery were retrospectively reviewed. Urinary tract infection was defined by culture or antibiotic prescription for symptoms. Recurrent UTI was defined as occurring outside a 6-week perioperative period. The χ 2 test or Fischer exact and Student t tests or Mann-Whitney U test were used as appropriate. Individual odds ratio (OR), 95% confidence interval [CI], and sequential multivariable logistic regression were calculated. Statistical significance was set at P < 0.05.
The 6-week PO-UTI rate after 33,626 procedures was 12.9%. Recurrent UTI increased from 3.7% preoperatively to 4.4% postoperatively ( P < 0.001). A 6-week preoperative UTI and RUTI increased the risk of 6-week PO-UTI (OR, 1.65; 95% CI < 1.26-2.16; P = 0.001 and OR, 2.19; 95% CI, 1.84-2.62; P < 0.001, respectively) and PO-RUTI (OR, 2.95; 95% CI, 2.11-4.11; P < 0.001 and OR, 6.79; 95% CI, 5.61-8.23; P < 0.001, respectively). Compared with pelvic organ prolapse (POP) surgery only, stress urinary incontinence (SUI) surgery (OR 1.57[1.30-1.89]), and combined POP/SUI surgery (OR, 1.36; 95% CI, 1.13-1.63]) increased the risk of PO-RUTI ( P < 0.001). Urinary tract infection within 1 week preoperatively was protective against 6-week PO-UTI (OR, 0.68; 95% CI, 0.48-0.97; P = 0.035). No perioperative factors were protective of PO-RUTI.
The PO-RUTI rate in the first year after urogynecologic surgery is low; however, SUI procedures may increase PO-RUTI risk. Potentially, modifiable risk factors for both PO-UTI and PO-RUTI include UTI diagnosis within 6 weeks preoperatively or preoperative RUTI diagnosis. Retesting women the week before surgery to ensure adequate treatment of preoperative UTI may reduce 6-week PO-UTI.
尿路感染（UTI）是妇科泌尿手术后常见且可能可避免的术后（PO）不良事件。了解其病理生理学有助于预防该疾病的相关发病率和 PO-UTI 的治疗。
本研究旨在确定以下内容：（1）妇科泌尿手术后 PO-UTI 和 PO 复发性 UTI（RUTI）的风险因素，（2）UTI 的时间分布，和（3）尿病原体鉴定。
对接受妇科泌尿手术的女性进行回顾性分析。UTI 通过培养或抗生素治疗症状来定义。复发性 UTI 定义为发生在 6 周围手术期之外。使用 χ 2 检验或 Fisher 精确检验和学生 t 检验或 Mann-Whitney U 检验，视情况而定。计算个体优势比（OR）、95%置信区间[CI]和顺序多变量逻辑回归。统计学意义设定为 P < 0.05。
33626 例患者的 6 周 PO-UTI 发生率为 12.9%。复发性 UTI 从术前的 3.7%增加到术后的 4.4%（P < 0.001）。术前 6 周 UTI 和 RUTI 增加了 6 周 PO-UTI 的风险（OR，1.65；95%CI <1.26-2.16；P = 0.001 和 OR，2.19；95%CI，1.84-2.62；P < 0.001，分别）和 PO-RUTI（OR，2.95；95%CI，2.11-4.11；P < 0.001 和 OR，6.79；95%CI，5.61-8.23；P < 0.001，分别）。与单纯盆腔器官脱垂（POP）手术相比，压力性尿失禁（SUI）手术（OR 1.57[1.30-1.89]）和联合 POP/SUI 手术（OR，1.36；95%CI，1.13-1.63]）增加了 PO-RUTI 的风险（P < 0.001）。术前 1 周内的 UTI 是预防 6 周 PO-UTI 的保护因素（OR，0.68；95%CI，0.48-0.97；P = 0.035）。没有围手术期因素可以预防 PO-RUTI。
妇科泌尿手术后第一年 PO-RUTI 的发生率较低；然而，SUI 手术可能会增加 PO-RUTI 的风险。PO-UTI 和 PO-RUTI 的潜在可改变风险因素包括术前 6 周内的 UTI 诊断或术前 RUTI 诊断。在手术前一周对女性进行重新检测，以确保术前 UTI 的充分治疗，可能会降低 6 周 PO-UTI 的发生率。
