Day of Surgery Urine Cultures Identify Urogynecologic Patients at Increased Risk for Postoperative Urinary Tract Infection
Day of Surgery Urine Cultures Identify Urogynecologic Patients at Increased Risk for Postoperative Urinary Tract Infection
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DOI：
10.1016/j.juro.2012.11.167
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发表时间：
2013-05-01
影响因子：
6.6
通讯作者：
Brubaker, Linda
中科院分区：
文献类型：
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作者：
Fok, Cynthia S.;McKinley, Kathleen;Brubaker, Linda
目的：尽管对尿路感染进行了术前筛查和治疗，但在大约五分之一的泌尿外科患者中，术后仍会发生尿路感染。在这项研究中，我们评估了手术日尿培养阳性的妇科患者的比例，手术培养阳性日的临床后果，以及基于手术日培养的术后尿路感染风险的差异。材料和方法：经过机构审查委员会的批准，罗约拉大学医学中心的妇科手术患者被招募为研究对象。静脉注射抗生素前于手术室采集留置尿液标本。如果在常规培养中发现每毫升1000个菌落或更多的细菌，则临床培养被认为是阳性。为了进行分析，我们将每名女性与两名年龄在10年内、手术组(即脱垂和/或大小便失禁)培养阴性的女性进行配对。使用SPSS(R)版本19对数据进行分析。结果：近十分之一(9.5%)的参与者手术当天培养呈阳性。在手术培养阴性和阳性的女性中，临床和人口学特征相似。然而，尽管围手术期使用标准抗生素(29.6%比5.6%，p=0.005，优势比7.2%)，但手术培养阳性的女性更有可能发生术后尿路感染。结论：近十分之一的妇科患者手术日细菌培养阳性。手术培养阳性的患者术后6周内发生尿路感染的风险增加(29.6%)。这些发现突出了识别和治疗手术培养阳性患者的机会，并减少了术后尿路感染的发生率。
Purpose: Despite preoperative screening and treatment for urinary tract infections, a postoperative urinary tract infection develops in approximately 1 in 5 urogynecologic patients. In this study we assess the proportion of urogynecologic patients with a positive day of surgery urine culture, the clinical consequences of a positive day of surgery culture and differences in postoperative urinary tract infection risks based on day of surgery culture.Materials and Methods: After institutional review board approval, patients undergoing urogynecologic surgery at Loyola University Medical Center were recruited for the study. Catheterized urine samples were collected in the operating room before intravenous antibiotic administration. Clinical cultures were considered positive if 1,000 colonies per ml or more bacteria were found on routine culture. For analysis we matched each woman with a positive culture with 2 women with negative culture by age within 10 years and within surgical groups (ie prolapse and/or incontinence). Data were analyzed using SPSS (R) version 19.Results: Nearly a tenth (9.5%) of participants had positive day of surgery cultures. The clinical and demographic characteristics were similar in women with negative vs positive day of surgery cultures. However, women with positive day of surgery cultures were more likely to experience a postoperative urinary tract infection despite standard perioperative antibiotic administration (29.6% vs 5.6%, p = 0.005, odds ratio 7.2). Regardless of day of surgery culture status no participant experienced postoperative systemic urinary complications.Conclusions: Nearly a tenth of urogynecologic patients had positive day of surgery cultures. Patients with a positive day of surgery culture had an increased risk (29.6%) of postoperative urinary tract infection within 6 weeks of surgery. These findings highlight an opportunity to identify and treat patients with positive day of surgery cultures and reduce the incidence of postoperative urinary tract infections.