Presentation Authors: Kelly Bree*, Carrie Jung, Linda Brubaker, San Diego, CA
Introduction: To describe timing and uropathogens of postoperative urinary tract infection (UTI) after female pelvic medicine and reconstructive surgery (FPMRS) procedures.
Methods: This IRB-approved study analyzed post-operative UTI occurring within 90 days following FPMRS procedures performed by five surgeons from November 2013 to January 2018 at a single academic institution. Postoperative UTI was defined as any uropathogen growth from standard urine culture. Continuous variables were compared with independent samples t-test and categorical variables with Chi-square or one-way ANOVA as appropriate.
Results: 102/1085 (9.4%) patients experienced UTI; 2.2% patients had >1 UTI. Surgical indication varied including pelvic organ prolapse (POP) only (41.4%), stress urinary incontinence (SUI) only (20.6%), combined POP and SUI (25.9%), bladder Botox (3.3%) and other (e.g. urethral diverticulectomy, anal sphincteroplasty) (8.8%). The range of UTI rates varied across surgeons (2.9â€“13.2%). The mean patient age was 61 years without group differences (p=0.895). The highest rate of post-operative UTI occurred in patient who underwent POP+UI surgery ((12.8%), compared to POP surgery (5.8%) or SUI surgery (6.5%) alone (p=0.003). Over half (63.7%) of the UTIs occurred in the first six weeks, with 23.7% occurring < 2 weeks and 36.3% occurred > 6 weeks. Most isolated uropathogens were E. coli (47.8%) with an additional 11.2% ESBL E. coli.. Additional organisms included E. faecalis (10.4%), and K. pneumoniae (9%), with 1 culture each for and K. pneumoniae ESBL and Vancomycin-resistant Enterococcus (VRE) faecium.
Conclusions: A majority of postoperative UTIs occur within the first six weeks after FPMRS procedures, but greater than 1/3 occur between postoperative day forty-two and ninety. Combined pelvic organ prolapse and stress urinary incontinence surgery has a greater postoperative UTI rate than surgery for either indication alone. Using standard urine culture, E. coli was the most commonly isolated uropathogen; ESBL pathogens were identified in over 10% of affected patients.