1544 • CID 2006:42 (1 June) • Ste ´phan et al.
M A J O R A R T I C L E
Reduction of Urinary Tract Infection and Antibiotic
Use after Surgery: A Controlled, Prospective, Before-
After Intervention Study
Franc ¸ois Ste ´phan,1,2,aHugo Sax,2Maud Wachsmuth,1,2Pierre Hoffmeyer,3Franc ¸ois Clergue,1and Didier Pittet2
1Division of Anesthesiology, Department of Anesthesiology, Pharmacology, and Surgical Intensive Care,
of Internal Medicine, and
2Infection Control Program, Department
3Clinic of Orthopedic Surgery, Department of Surgery, University of Geneva Hospitals, Geneva, Switzerland
that the implementation of a multifaceted prevention strategy could decrease its incidence after surgery.
In a controlled, prospective, before-after intervention trial with 1328 adult patients scheduled for
orthopedic or abdominal surgery, nosocomial infection surveillance was conducted until hospital discharge. A
multifaceted intervention including specifically tailored, locally developed guidelines for the prevention of urinary
tract infection was implemented for orthopedic surgery patients, and abdominal surgery patients served as control
subjects. Infectious and noninfectious complications, adherence to guidelines, and antibiotic use were monitored
before and after the intervention and again 2 years later.
The incidence of urinary tract infection decreased from 10.4 to 3.9 episodes per 100 patients in the
intervention group (incidence-density ratio, 0.41; 95% CI, 0.20–0.79;
82.2%. Both the frequency and the duration of urinary catheterization decreased following the intervention.
Recourse to antibiotic therapy after surgery dropped in the intervention group from 17.9 to 15.6 defined daily
doses per 100 patient-days ( ) because of a reduced need for the treatment of urinary tract infectionP ! .005
( ). Follow-up after 2 years revealed a sustained impact of the strategyandasubsequentlowuseofantibiotics,P ! .001
consistent with stable adherence to guidelines (80.8%).
A multifaceted prevention strategy can dramatically decrease postoperative urinarytractinfection
and contribute to the reduction of the overall use of antibiotics after surgery.
Urinary tract infection is the most frequent health care–associatedcomplication.Wehypothesized
). Adherence to guidelines wasP p .004
complication following joint prosthesis surgery [1, 2].
Presence of an indwelling urinary catheter is the main
risk factor for infection [1, 3, 4]. In addition to the
associated economic burden and patient morbidity [1,
2, 5, 6], UTIs contribute to the inappropriate and ex-
cessive use of antimicrobial agents and lead to the se-
lection of antibiotic-resistantorganisms,therebycreating
a potential reservoir of resistant pathogens [1, 3, 7].
Received 23 September 2005; accepted1February2006;electronicallypublished
25 April 2006.
aPresent affiliation: Department of Anesthesiology-Critical Care Medicine,
Point-a `-Pitre Hospital, University of Antilles-Guyane, Pointe-a `-Pitre Cedex, France.
Reprints or correspondence: Dr. Didier Pittet, Infection Control Program, Dept.
of Internal Medicine, University of Geneva Hospitals, 24 Rue Micheli du Crest,
1211 Geneva 14 Switzerland (firstname.lastname@example.org).
Clinical Infectious Diseases 2006;42:1544–51
? 2006 by the Infectious Diseases Society of America. All rights reserved.
In most hospitals, urinary catheters are placed by
anesthesiologists in the operating room and the pos-
tanesthesia care unit, and surgeons and nurses handle
the placement of indwelling devices for patients in the
surgical ward. Management of urinary problems relies
more on the physician’s experience and the surgery
department’s practice patterns than on evidence-based
data. Specific recommendations related tourinarycath-
eter placement during surgical procedures are lacking
not only in anesthesiology and surgery textbooks, but
also in published guidelines issued by localandnational
authorities [8–10]. We performed a multifaceted, mul-
tidisciplinary intervention study to decrease the inci-
dence of nosocomial UTI in surgical patients and
thereby improve quality of care and patient safety.
prospective, before-after intervention trial (quasi-ex-
We conducted a 3-phase, controlled,
by guest on December 21, 2015
Preventing UTI After Surgery • CID 2006:42 (1 June) • 1551
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