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Antibiotic Prophylaxis for Urinary Tract Infection After Midurethral Sling: A Randomized Controlled Trial

Jackson, Daniel; Higgins, Edmund; Bracken, Jessica; Yandell, Paul M.; Shull, Bob; Foster, Raymond T. Sr

Obstetrical & Gynecological Survey: August 2013 - Volume 68 - Issue 8 - p 563–564
doi: 10.1097/01.ogx.0000433841.18956.93
Gynecology: Urogynecology

Stress urinary incontinence (SUI) is common in adult women and is often treated by the placement of a midurethral sling. Postoperative urinary tract infection (UTI) is a frequent complication of this surgery. Its incidence varies widely (8.9%–34%). Two previous studies reported that the use of prophylactic antibiotics following sling placement decreased the incidence of UTI.

The aim of this randomized, double-blinded, placebo-controlled, multicenter trial was to determine whether a 3-day postoperative course of a urinary antibiotic would lower the incidence of UTI in women undergoing outpatient midurethral sling placement for SUI. Adult women with SUI undergoing placement of a midurethral sling were randomized to receive oral doses of nitrofurantoin 100 mg (n = 74) or placebo (n = 75) twice daily for 3 days after surgery. All participants and caregivers were blinded to the randomization. Subjects were observed for signs and symptoms of UTI until 6 weeks after surgery and were evaluated at that time for occurrence of UTI, the primary study outcome.

The overall rate of UTI during the study period was 24.8% (n = 37). The incidence of postoperative UTI was significantly lower in the treatment group than in the placebo group (17.6% vs 32%; P = 0.04).

These findings show that a 3-day course of nitrofurantoin reduces the risk of postoperative UTI in the first 6 weeks after sling surgery in this study population. The authors recommend that all patients receiving an outpatient miduretheral sling be treated with a course of nitrofurantoin.

Department of Obstetrics, Gynecology, and Women’s Health (D.J., R.T.F.), School of Medicine, University of Missouri, Columbia, MO; and Department of Obstetrics and Gynecology (E.H., J.B., P.M.Y., B.S), Scott and White Hospital, Texas A&M University System Health Sciences Center, Temple, TX

© 2013 by Lippincott Williams & Wilkins.