A recent Best Practice Statement published by the American Urological Association (AUA) recommends that antibiotic therapy in patients undergoing midurethral synthetic slings (MUS) should be 24 hours or less. Subjects at our institution are routinely administered a single dose of intravenous antibiotics before MUS surgery. We prospectively evaluated urinary tract infection (UTI) rates and risk factors for UTI in subjects undergoing MUS who receive single-dose antibiotic therapy.
Adult female patients who were undergoing MUS for stress or mixed urinary incontinence were prospectively included and received a single-dose of an intravenous antibiotic in accordance with the AUA Best Practice Statement. Subjects requiring additional procedures for prolapse were excluded. Baseline characteristics and preoperative and postoperative postvoid residual (PVR) were documented. Subjects were contacted within 1 week of surgery, and seen in the office at 1 month, when a urinalysis was performed, and urine culture sent if subjects were symptomatic.
A total of 101 subjects underwent solitary MUS and received a single dose of intravenous antibiotics. Overall, 6 (5.9%) subjects developed a UTI within 1 month of surgery. Patients who developed a UTI were more likely to have elevated PVRs at the preoperative office visit (62.2 vs 26.8 mL, P = .004).
Our study has demonstrated that the rate of perioperative UTI after MUS with one perioperative dose of intravenous antibiotics is low. Patients with an elevated preoperative PVR may be at an increased risk of developing a UTI. Single-dose antibiotic administration is safe and effective at preventing perioperative UTI in subjects undergoing solitary MUS.
[Show abstract][Hide abstract] ABSTRACT: The objective of this study was to determine if prophylactic antibiotic use before midurethral sling procedures reduces infectious complications.
In this double-blinded randomized trial, we compared infectious complications between women who received cefazolin and placebo before midurethral sling procedures.
The study was halted due to low rate of infectious outcomes seen at the first scheduled interim analysis. We enrolled 29 women in the cefazolin group and 30 in the placebo group. Total follow-up was 6 months (3-24 months). The groups were similar at the baseline. There was no statistically significant difference between the cefazolin and placebo groups, respectively, with respect to wound infections [1 (3.3%) and 0 (0%)], mesh exposure [0 (0%) and 1 (3.5%)], and bacteriuria [3 (10%) and 1 (3.5%)].
Because infection rates are low in both cefazolin and placebo groups, omitting preoperative antibiotics for midurethral slings may be justified.
International Urogynecology Journal 07/2011; 22(10):1249-53. DOI:10.1007/s00192-011-1500-6 · 1.96 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Despite the lack of evidence, antibiotic prophylaxis has been recommended for midurethral sling procedures. The goal of this study was to evaluate the rate of infectious complications in women undergoing midurethral sling procedures without antibiotic prophylaxis.
We reviewed the baseline characteristics and postoperative infectious complications of 174 consecutive women who underwent midurethral sling procedures without prophylactic antibiotics from April 2005 to January 2010. Patients undergoing concomitant vaginal surgery were excluded.
The average age, parity, and body mass index of were 51.3 ± 12.6 years, 2.4 ± 1.3, and 30.1 ± 7.4 kg/m(2), respectively. There were no wound infections, 2 (1.4%) vaginal mesh exposures and 12 (8%) cases of bacteriuria.
The risk of infections is low when a midurethral sling is performed without antibiotic prophylaxis. Antibiotic prophylaxis does not appear to offer any benefit in midurethral sling procedures.
International Urogynecology Journal 12/2011; 23(5):621-3. DOI:10.1007/s00192-011-1624-8 · 1.96 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: While surgical options for stress urinary incontinence and pelvic organ prolapse continue to become less-invasive, complications can still occur. Measures to standardize the preoperative diagnosis and treatment options are currently being developed. Likewise, the American Urological Association has developed best practice statements regarding the administration of perioperative antibiotics and prevention of deep vein thrombosis in patients undergoing pelvic surgery. Furthermore, other perioperative steps, such as the type of bowel preparation and proper patient positioning, play a significant role in perioperative morbidity. A discussion of available evidence regarding these perioperative issues is presented in this paper.
Current Bladder Dysfunction Reports 09/2012; 7(3). DOI:10.1007/s11884-012-0135-x
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