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Antibiotic Stewardship and Postoperative Infections in Urethroplasties
Journal article   Open access   Peer reviewed

Antibiotic Stewardship and Postoperative Infections in Urethroplasties

Sunchin Kim, Katherine C Cheng, Saatchi Patell, Nejd F Alsikafi, Benjamin N Breyer, Joshua A Broghammer, Sean P Elliott, Bradley A Erickson, Jeremy B Myers, Thomas G Smith III, …
Urology (Ridgewood, N.J.), Vol.152, pp.142-147
06/2021
DOI: 10.1016/j.urology.2020.10.065
PMID: 33373707
url
https://escholarship.org/uc/item/4wd5h322View
Published (Version of record) Open Access

Abstract

To determine surgical site infection and urinary tract infection (UTI) rates in the setting of urethroplasty. Given significant variation in the utilization of antibiotics, there is an opportunity to improve antibiotic stewardship. This study aims to elucidate the rate of both UTI and surgical site infection after urethroplasty on a standardized perioperative antibiotic regimen, and to obtain patient and operative characteristics that may predict infection. We prospectively treated 390 patients undergoing urethroplasty at 11 centers with a standardized perioperative antibiotic protocol. Patients had a urine culture or urine analysis within 3 weeks of surgery. After surgery, patients were discharged with an indwelling catheter, removed per usual surgeon practice. All were given nitrofurantoin from discharge until catheter removal. Logistic regression analyses were performed to determine the correlation between patient characteristics or operative categories with post-operative infection. The rates of postoperative UTI and wound infection within 30 days were 6.7% and 4.1%, respectively. On multivariate analysis of demographics, comorbidities, and stricture characteristics and repair, only preoperative UTI (P = .012), history of cardiovascular disease (P = .015), and performing a membranous urethroplasty (0.018) were significant predictors of a UTI within 30 days postoperatively. Location of repair nor graft use increased the risk of UTI. There were no factors predictive of postoperative wound infection. A standardized antibiotic protocol was created to narrow and limit excess antibiotic use. This protocol, with clear definitions of UTI and wound infection, allowed determination of accurate infection rates in urethroplasties. Preoperative UTI, even when properly treated, increases the risk of postoperative UTI.
 Adult Aged Anti-Bacterial Agents - therapeutic use Antimicrobial Stewardship - standards Antimicrobial Stewardship - statistics & numerical data Catheters, Indwelling - adverse effects Follow-Up Studies Humans Incidence Male Middle Aged Nitrofurantoin - therapeutic use Perioperative Care - standards Perioperative Care - statistics & numerical data Practice Guidelines as Topic Prospective Studies Reconstructive Surgical Procedures - adverse effects Reconstructive Surgical Procedures - methods Risk Assessment - statistics & numerical data Risk Factors Surgical Wound Infection - drug therapy Surgical Wound Infection - epidemiology Surgical Wound Infection - etiology Urethra - surgery Urethral Stricture - surgery Urinary Tract Infections - drug therapy Urinary Tract Infections - epidemiology Urinary Tract Infections - etiology Urologic Surgical Procedures, Male - adverse effects Urologic Surgical Procedures, Male - methods

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