Infectious Complications in Patients With Chronic Bacteriuria Undergoing Major Urologic Surgery
Received 24 March 2009; accepted 10 September 2009. published online 23 November 2009.
Objectives
To review our perioperative antibiotic management of patients with chronic bacteriuria who underwent urological procedures, and the relationship to postoperative infectious complications.
Methods
Between January 2002 and January 2007, 77 patients with chronic bacteriuria underwent 94 major open procedures, including ileocystoplasty (n = 53), ileal conduit (n = 19), and pubovaginal sling placement (n = 18). Admission urine cultures were classified as “sensitive” (sensitive to admission antibiotics or no growth), “resistant” (resistant to admission antibiotics), and “unknown” (multiple unspeciated organisms present or no admission culture data available).
Results
Our rate of multidrug resistance bacteriuria was 46.3%. There were 7 febrile urinary tract infections, 12 wound infections, 1 episode of sepsis, and no intra-abdominal abscesses, yielding an infectious complication rate of 20.2%. There was no statistical relationship between urine culture status and the rate of febrile urinary tract infections or sepsis, but wound infections were less common in patients with “sensitive” urine cultures. Of the patients who had urine cultures that demonstrated multiple unspeciated organisms, 32% were complicated by wound infections. On multivariate analysis, gender, age, and body mass index were associated with the development of infectious complications.
Conclusions
In a medically complex population of patients, those with neurogenic bladder and frequent catheterization undergoing major abdominal surgery, we demonstrate an infectious complication rate of 20.2%. Wound infections were as common in patients whose urine cultures revealed multiple unspeciated organisms as those that were resistant to the perioperative antibiotics, and in this population, further characterization may allow for more appropriate perioperative coverage and a decreased rate of wound infections.
aDepartment of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
bDepartment of Epidemiology, University of Michigan Medical Center, Ann Arbor, Michigan
cDepartment of Urology, University of Michigan Medical Center, Ann Arbor, Michigan
Reprint requests: J. Quentin Clemens, M.D., Department of Urology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48130
ABSTRACT