title: Day of surgery urine cultures identify urogynecologic patients at increased risk for postoperative urinary tract infection.
abstract: OBJECTIVE
  Despite preoperative screening and treatment for urinary tract infections, a postoperative urinary tract infection develops in approximately 1 in 5 urogynecologic patients. In this study we assess the proportion of urogynecologic patients with a positive day of surgery urine culture, the clinical consequences of a positive day of surgery culture and differences in postoperative urinary tract infection risks based on day of surgery culture.
  
  
  METHODS
  After institutional review board approval, patients undergoing urogynecologic surgery at Loyola University Medical Center were recruited for the study. Catheterized urine samples were collected in the operating room before intravenous antibiotic administration. Clinical cultures were considered positive if 1,000 colonies per ml or more bacteria were found on routine culture. For analysis we matched each woman with a positive culture with 2 women with negative culture by age within 10 years and within surgical groups (ie prolapse and/or incontinence). Data were analyzed using SPSS® version 19.
  
  
  RESULTS
  Nearly a tenth (9.5%) of participants had positive day of surgery cultures. The clinical and demographic characteristics were similar in women with negative vs positive day of surgery cultures. However, women with positive day of surgery cultures were more likely to experience a postoperative urinary tract infection despite standard perioperative antibiotic administration (29.6% vs 5.6%, p = 0.005, odds ratio 7.2). Regardless of day of surgery culture status no participant experienced postoperative systemic urinary complications.
  
  
  CONCLUSIONS
  Nearly a tenth of urogynecologic patients had positive day of surgery cultures. Patients with a positive day of surgery culture had an increased risk (29.6%) of postoperative urinary tract infection within 6 weeks of surgery. These findings highlight an opportunity to identify and treat patients with positive day of surgery cultures and reduce the incidence of postoperative urinary tract infections.
authors.affiliation: Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Urology, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA. csfok@lumc.edu
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Fok
authors.forename: Kathleen
authors.initials: K
authors.lastname: McKinley
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Mueller
authors.forename: Kimberly
authors.initials: K
authors.lastname: Kenton
authors.forename: Paul
authors.initials: P
authors.lastname: Schreckenberger
authors.forename: Alan
authors.initials: A
authors.lastname: Wolfe
authors.forename: Linda
authors.initials: L
authors.lastname: Brubaker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000382:microbiology*; D011300:Preoperative Care; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016482:Urinalysis; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000382:microbiology*; D014556:Urine / Q000382:microbiology*; D013520:Urologic Surgical Procedures