The records of 196 women who underwent colposuspension for genuine stress incontinence at the Leicester General Hospital, England, between June 1991 and May 1996 were reviewed for evidence of urinary tract infection (UTI). Variables analyzed include age, type of anbibiotic, timing of a positive culture, organism(s) responsible and antibiotic sensitivity. Forty-six patients (23.47%) developed urinary infection; of these, 42 had received single-dose antibiotic prophylaxis with suprapubic catheterization. Thirty-two (76%) of those who developed UTI received augmentin (amoxycillin and clavulanic acid), whereas 10 (24%) were given cefuroxime and metronidazole. Positive cultures were obtained between postoperative days 3 and 28, with a mean of 9.6 days, and 81% occurred after the 7th day. Coliform organisms were responsible for nearly 70% of the infections. UTI is still common after colposuspension, despite single-dose antibiotic prophylaxis. Further studies looking at longer or alternative courses of antibiotics or clean intermittent self-catheterization are essential to establish the best way of curbing UTI in urogynecology patients.
Keywords Antibiotic prophylaxis - Colposuspension - Intermittent self-catheterization - Suprapublic catheterization - UTI
Editorial Comment: The authors present a summary of their experience with symptomatic urinary tract infection (UTI) after colposuspension, the patients having received a single dose of antibiotics preoperatively. Symptomatic urinary tract infections are described with regard to time of onset, length of suprapubic catheterization, pathogen and antibiotic sensitivity. One of the most interesting findings in this cohort of patients is the incidence of UTI over time, with the majority of infections occurring in the second postoperative week, and falling off dramatically thereafter. This is in contrast to the incidence of urinary tract infections with transurethral catheterization, where published experience suggests at 5%–10% increase in positive cultures for every day of transurethral catheterization, and almost universal positive cultures by 30 days. The results question the utility of preoperative single-dose antibiotic therapy in the prevention of UTI following colposuspension. Further investigation is needed to clarify what prophylactic antibiotic regimen is useful in preventing post-colposuspension infection of the lower urinary tract.