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Risk factors for urinary tract infection following incontinence surgery

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International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

The purpose of this study is to describe risk factors for post-operative urinary tract infection (UTI) the first year after stress urinary incontinence surgery.

Methods

Multivariable logistic regression analyses were performed on data from 1,252 women randomized in two surgical trials, Stress Incontinence Surgical Treatment Efficacy trial (SISTEr) and Trial Of Mid-Urethral Slings (TOMUS).

Results

Baseline recurrent UTI (rUTI; ≥3 in 12 months) increased the risk of UTI in the first 6 weeks in both study populations, as did sling procedure and self-catheterization in SISTEr, and bladder perforation in TOMUS. Baseline rUTI, UTI in the first 6 weeks, and PVR > 100 cc at 12 months were independent risk factors for UTI between 6 weeks and 12 months in the SISTEr population. Few (2.3–2.4%) had post-operative rUTI, precluding multivariable analysis. In women with pre-operative rUTI, successful surgery (negative cough stress test) at 1 year did not appear to decrease the risk of persistent rUTI.

Conclusions

Pre-operative rUTI is the strongest risk factor for post-operative UTI.

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Acknowledgments

This study was supported by NIH grants U01 DK58231, U01 DK60379, U01 DK60380, U01 DK60401, U01 DK60397, U01 DK 58225, U01 DK60395, U01 DK58234, U01 DK60393, U01 DK58229.

Conflicts of interest

The authors report no financial disclosures with the following exceptions: Linda Brubaker received grant support and honorarium from Pfizer; Toby Chai received grant support from Allergan and honorarium from Pfizer; Anne Stoddard has stocks in Bristol-Meyers Squibb, Johnson and Johnson, Elan Corp., Proctor and Gamble, and Stryker.

Author information

Authors and Affiliations

  1. Department of OB/GYN, University Utah, Salt Lake City, UT, USA

    Ingrid Nygaard

  2. Departments of OB/GYN and Urology, Loyola, Chicago, IL, USA

    Linda Brubaker

  3. Division of Urology, University of Maryland Baltimore, Baltimore, MD, USA

    Toby C. Chai

  4. Department of Medicine, Division of Geriatrics, Gerontology, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA

    Alayne D. Markland

  5. Department of OB/GYN, Kaiser Permenente San Diego, San Diego, CA, USA

    Shawn A. Menefee

  6. Department of Urology, William Beaumont Hospital, Royal Oak, MI, USA

    Larry Sirls

  7. Department of OB/GYN, Magee Women’s Hospital, Pittsburgh, PA, USA

    Gary Sutkin

  8. Department of Urology, University Texas Southwestern, Dallas, TX, USA

    Phillipe Zimmern

  9. Department of Urology, University of Texas San Antonio, San Antonio, TX, USA

    Amy Arisco

  10. New England Research Institutes, Watertown, MA, USA

    Liyuan Huang, Sharon Tennstedt & Anne Stoddard

  11. University of Utah School of Medicine, 30N 1900 E, Salt Lake City, UT, 84132, USA

    Ingrid Nygaard

Authors
  1. Ingrid Nygaard
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  2. Linda Brubaker
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  3. Toby C. Chai
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  4. Alayne D. Markland
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  5. Shawn A. Menefee
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  6. Larry Sirls
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  7. Gary Sutkin
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  8. Phillipe Zimmern
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  9. Amy Arisco
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  10. Liyuan Huang
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  11. Sharon Tennstedt
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  12. Anne Stoddard
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Corresponding author

Correspondence to Ingrid Nygaard.

Appendix

Appendix

For SISTEr

Steering committee

William Steers, M.D., Chair (University of Virginia Charlottesville, VA); Ananias Diokno, M.D., Veronica Mallett, M.D. (William Beaumont Hospital, Royal Oak, MI, and Oakwood Hospital, Dearborn, MI; U01 DK58231); Linda Brubaker, M.D., and MaryPat FitzGerald, M.D. (Loyola University Medical Center, Maywood, IL; U01 DK60379); Holly E. Richter, Ph.D., M.D., L. Keith Lloyd, M.D. (University of Alabama, Birmingham, AL; U01 DK60380); Michael Albo, M.D., Charles Nager, M.D. (University of California, San Diego, CA; U01 DK60401); Toby C. Chai, M.D.; Harry W. Johnson, M.D. (University of Maryland, Baltimore, M.D.; U01 DK60397); Halina M. Zyczynski, M.D.; Wendy Leng, M.D. (University of Pittsburgh, Pittsburgh, PA; U01 DK 58225); Philippe Zimmern, M.D.; Gary Lemack, M.D. (University of Texas Southwestern, Dallas, TX; U01 DK60395); Stephen Kraus, M.D.; Thomas Rozanski, M.D. (University of Texas Health Sciences Center, San Antonio, TX; U01 DK58234); Peggy Norton, M.D.; David Lesser, M.D. (University of Utah, Salt Lake City, UT; U01 DK60393); Sharon Tennstedt, Ph.D.; Anne Stoddard, ScD (New England Research Institutes, Watertown, MA; U01 DK58229); Debuene Chang, M.D.; John W. Kusek, Ph.D.; Leroy M. Nyberg, M.D., Ph.D. (National Institute of Diabetes & Digestive & Kidney Diseases); Anne M. Weber, M.D. (National Institute of Child Health and Human Development).

Co-investigators

Rowell S. Ashford II, M.D.; Jan Baker, APRN; Diane Borello-France, PT, Ph.D.; Kathryn L. Burgio, Ph.D.; Seine Chiang, M.D.; Ash Dabbous, M.D.; Patricia S. Goode, M.D.; Lee N. Hammontree, M.D.; Kimberly Kenton, M.D.; Salil Khandwala, M.D.; Karl Luber, M.D.; Emily Lukacz, M.D.; Shawn Menefee, M.D.; Pamela Moalli, M.D.; Kenneth Peters, M.D.; Elizabeth Sagan, M.D.; Joseph Schaffer, M.D.; Amanda Simsiman, M.D.; Larry Sirls, M.D.; Robert Starr, M.D.; R. Edward Varner, M.D..

Study coordinators

Rosemary Bradt, RNC; Karen Debes, RN; Rosanna Dinh, RN, CCRC; Judy Gruss, RN; Lynn Hall, RN, MSN, CURN; Alice Howell, RN, BSN, CCRC; Kathy Jesse, RN; D. Lynn Kalinoski, Ph.D.; Kathryn Koches, RN; Barbara Leemon, RN; Karen Mislanovich, RN; Shelly O'Meara, RN; Janese Parent, RN; Norma Pope, RN; Caren Prather, RN; Terry Rogers, RN; Sylvia Sluder, CCRP; Mary Tulke, RN.

Biostatistical coordinating center

Kimberly J. Dandreo, MSc; Corinne J. Leifer, BA; Susan M. McDermott, MPH, GNP; Anne Stoddard, ScD (Co-PI); Sharon Tennstedt, Ph.D. (PI); Liane Tinsley, MPH; Lisa Wruck, ScD; Yan Xu, MS.

Data safety and monitoring board

Elizabeth A. Gormley, M.D. (Chair), Dartmouth-Hitchcock Medical Center, Lebanon NH; Paul Abrams, M.D., Bristol Urological Institute, Bristol, UK; Diedre Bland, M.D., Blue Ridge Medical Associates, Winston Salem NC; J. Quentin Clemens, M.D., Northwestern University Medical School, Chicago, IL; John Connett, Ph.D., University of Minnesota, Minneapolis, MN; William Henderson, Ph.D., University of Colorado, Aurora, CO; Dee Fenner, M.D., University of Michigan; Ann Arbor, MI; Sheryl Kelsey, Ph.D., University of Pittsburgh, Pittsburgh, PA; Deborah Myers, M.D., Brown University School of Medicine, Providence, RI; Jacek Mostwin, M.D., Johns Hopkins Hospital, Baltimore, MD; Bassem Wadie, MBBCh, MSc, M.D., Mansoura Urology and Nephrology Center, Mansoura, Egypt.

For TOMUS

Steering committee

Elizabeth A. Gormley, Chair (Dartmouth-Hitchcock Medical Center, Lebanon, NH); Larry Sirls, M.D.; Salil Khandwala, M.D. (William Beaumont Hospital, Royal Oak, MI, and Oakwood Hospital, Dearborn, MI; U01 DK58231); Linda Brubaker, M.D.; Kimberly Kenton, M.D. (Loyola University Chicago, Stritch School of Medicine, Maywood, IL; U01 DK60379); Holly E. Richter, Ph.D., M.D.; L. Keith Lloyd, M.D. (University of Alabama, Birmingham, AL; U01 DK60380); Michael Albo, M.D.; Charles Nager, M.D. (University of California, San Diego, CA; U01 DK60401); Toby C. Chai, M.D.; Harry W. Johnson, M.D. (University of Maryland, Baltimore, MD; U01 DK60397); Halina M. Zyczynski, M.D.; Wendy Leng, M.D. (University of Pittsburgh, Pittsburgh, PA; U01 DK 58225); Philippe Zimmern, M.D.; Gary Lemack, M.D. (University of Texas Southwestern, Dallas, TX; U01 DK60395); Stephen Kraus, M.D.; Thomas Rozanski, M.D. (University of Texas Health Sciences Center, San Antonio, TX; U01 DK58234); Peggy Norton, M.D.; Ingrid Nygaard, M.D. (University of Utah, Salt Lake City, UT; U01 DK60393); Sharon Tennstedt, Ph.D.; Anne Stoddard, ScD (New England Research Institutes, Watertown, MA; U01 DK58229); Debuene Chang, M.D. (until 10/2009), John Kusek, Ph.D. (starting 10/2009), Rebekah Rasooly, Ph.D. (National Institute of Diabetes & Digestive & Kidney Diseases).

Co-investigators

Amy Arisco, M.D.; Jan Baker, APRN; Diane Borello-France, PT, Ph.D.; Kathryn L. Burgio, Ph.D.; Ananias Diokno, M.D.; MaryPat Fitzgerald, M.D.; Chiara Ghetti, M.D.; Patricia S. Goode, M.D.; Robert L. Holley, M.D.; Yvonne Hsu, M.D.; Margie Kahn, M.D.; Jerry Lowder, M.D.; Karl Luber, M.D.; Emily Lukacz, M.D.; Alayne Markland, DO, MSc; Shawn Menefee, M.D.; Pamela Moalli, M.D.; Elizabeth Mueller, M.D.; Leslie Rickey, M.D., MPH; Elizabeth Sagan, M.D.; Joseph Schaffer, M.D.; Robert Starr, M.D.; Gary Sutkin, M.D.; R. Edward Varner, M.D.; Emily Whitcomb, M.D..

Study coordinators

Laura Burr, RN; JoAnn Columbo, BS, CCRC; Tamara Dickinson, RN, CURN, CCCN, BCIA-PMDB; Rosanna Dinh, RN, CCRC; Judy Gruss, RN; Alice Howell, RN, BSN, CCRC; Chaandini Jayachandran, MSc; Kathy Jesse, RN; D. Lynn Kalinoski, Ph.D.; Barbara Leemon, RN; Karen Mislanovich, RN; Elva Kelly Moore, RN; Caren Prather, RN; Jennifer Tabaldo; Tia Thrasher; Mary Tulke, RN; Robin Willingham, RN, BSN; Kimberly Woodson, RN, MPH; Gisselle Zazueta-Damian.

Data coordinating center

Kathleen Cannon, BS; Kimberly J. Dandreo, MSc; Liyuan Huang, MS; Rose Kowalski, MA; Heather Litman, Ph.D.; Marina Mihova, MHA; Anne Stoddard, ScD (Co-PI); Kerry Tanwar, BA; Sharon Tennstedt, Ph.D. (PI); Yan Xu, MS.

Data safety and monitoring board

J. Quentin Clemens, M.D. (Chair) Northwestern University Medical School, Chicago IL; Paul Abrams, M.D., Bristol Urological Institute, Bristol, UK; Deidre Bland, M.D., Blue Ridge Medical Associates, Winston Salem, NC; Timothy B. Boone, M.D., The Methodist Hospital, Baylor College of Medicine, Houston, TX; John Connett, Ph.D., University of Minnesota, Minneapolis, MN; Dee Fenner M.D., University of Michigan, Ann Arbor, MI; William Henderson, Ph.D., University of Colorado, Aurora, CO; Sheryl Kelsey, Ph.D., University of Pittsburgh, Pittsburgh, PA; Deborah J. Lightner, M.D., Mayo Clinic, Rochester, MN; Deborah Myers, M.D., Brown University School of Medicine, Providence, RI; Bassem Wadie, MBBCh, MSc, M.D., Mansoura Urology and Nephrology Center, Mansoura, Egypt; J. Christian Winters, M.D., Louisiana State University Health Sciences Center, New Orleans, LA

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Nygaard, I., Brubaker, L., Chai, T.C. et al. Risk factors for urinary tract infection following incontinence surgery. Int Urogynecol J 22, 1255–1265 (2011). https://doi.org/10.1007/s00192-011-1429-9

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  • DOI: https://doi.org/10.1007/s00192-011-1429-9

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