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The Effect of Catheterization on Susceptibility of Uropathogens After Pelvic Reconstructive Surgery

Baird, Rachael C., BS*; Romich, Ellen, BS*; Holthaus, Emily, MD*; Barber, Matthew D., MD, MHS; Ferrando, Cecile A., MD, MPH*

Female Pelvic Medicine & Reconstructive Surgery: November 17, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/SPV.0000000000000660
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Objective The aim of this study was to determine whether bacterial uropathogens from positive urine cultures and uropathogen antibiotic susceptibility differ between catheterized (C) and noncatheterized (NC) patients after pelvic reconstructive surgery.

Methods This is a retrospective cohort study of patients with a positive urine culture within 1 year of pelvic reconstructive surgery. Patients were categorized as having an indwelling catheter placed for urinary retention or voiding dysfunction within 48 hours of specimen collection versus no catheter. Microbiology reports provided uropathogens and antibiotic susceptibility for each culture. Student t test, χ2, and logistic regression were used to compare rates of non–Escherichia coli uropathogens and susceptibility to first-line antibiotics between C and NC groups.

Results A total of 427 positive urine cultures from 317 unique patients were identified. Positive urine cultures from C patients were less likely to contain E. coli (47.1% NC vs 29.2% C; P = 0.0009), with enterococcus being the most common non–E. coli uropathogen. The odds of non–E. coli uropathogens increased with age (adjusted odds ratio, 4.25; 95% confidence interval, 1.95–9.28; P = 0.0003 for the oldest patients). Cultures from C patients were more likely to have a uropathogen not susceptible to sulfamethoxazole/trimethoprim (20.5% NC vs 32.1% C; P = 0.03), nitrofurantoin (19.2% NC vs 34.6% C; P = 0.002), and cefazolin (18.1% NC vs 49.4% C; P < 0.0001).

Conclusions After pelvic reconstructive surgery, patients with a positive urine culture who have undergone catheterization within 48 hours of specimen collection are more likely to have non–E. coli uropathogens, with 1 in 3 cultures being not susceptible to common first-line antibiotics. This highlights the importance of performing susceptibility testing rather than treating empirically after pelvic reconstructive surgery.

From the *Center for Urogynecology and Pelvic Reconstructive Surgery, Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic, Cleveland, OH; and †Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC.

Correspondence: Cecile A. Ferrando, MD, MPH, Center for Urogynecology and Pelvic Reconstructive Surgery, Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic, 9500 Euclid Avenue A81, Cleveland, OH 44196. E-mail: ungerc@ccf.org.

The authors have declared they have no conflicts of interest.

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