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Impact of per-operative antibiotics on the urinary tract infection rate following mid-urethral sling surgery for urinary incontinence: a randomized controlled trial

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Abstract

Introduction and hypothesis

The objective was to compare the effect of antibiotics versus no antibiotics prophylaxis per-operatively on the frequency of urinary tract infection (UTI) following mid-urethral sling application to treat stress or mixed urinary incontinence.

Methods

This study was designed as a multicenter prospective randomized trial. Women were included from eight centers in three countries. Women were aged under 60 years and had objectively verified stress urinary incontinence. Women with mixed urinary incontinence were also included. Randomization was held in blocks for operation with either antibiotics or no antibiotics. UTI was defined in accordance with the Centers for Disease Control (CDC) criteria for symptomatic UTI. Women were followed up at 3, 12, and 36 months. This was part of a trial comparing subjective cure rate in relation to application of Ajust® (single-incision mid-urethral slings) versus standard mid-urethral slings.

Results

The main outcome was to evaluate if per-operative antibiotics had any impact on UTI following sling surgery. In total, 305 women were randomized (158 [52%] to antibiotics and 147 [48%] to no antibiotics). Demographic data disclosed no differences between the two groups. The trial did not show any difference between the two groups regarding the frequency of postoperative UTI. Logistic regression analysis disclosed only residual urine volume at 3 months’ follow-up as a significant risk factor for UTIs. Per-operative antibiotics had no influence on the frequency of mesh erosions or any other complication.

Conclusions

Our trial does not suggest any beneficial effect of per-operative antibiotics on the risk of post-operative UTIs.

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Abbreviations

MUI:

Mixed urinary incontinence

NFOG:

Nordic Federation of Obstetrics and Gynecology

SIMS:

Single-incision mid-urethral slings

SMUS:

Standard mid-urethral slings

SUI:

Stress urinary incontinence

UTI:

Urinary tract infection

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Acknowledgements

We thank Katarina von Bothmer Östling from Halmstad Hospital in Sweden, Anja Holstad from Gjøvik Hospital in Norway, Claes Magnusson from Sahlgrenska University Hospital in Sweden, Memona Majida from Ahus University Hospital in Norway, and Constanze Merkel from Regional Hospital of Northern Jutland in Denmark for their vital contributions to the development of this project. We also thank all the women who participated in this study and shared their experiences.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark

    Martin Rudnicki

  2. Department of Clinical Research, University of Southern Denmark, Odense, Denmark

    Martin Rudnicki

  3. Center for Primary Healthcare Research, Clinical Research Center, Box 50332, 202 13, Malmö, Sweden

    Ulf Jakobsson

  4. Department of Obstetrics and Gynecology, Skane University Hospital, Lund University, Klinikgatan 12, 221 85, Lund, Sweden

    Pia Teleman

Authors
  1. Martin Rudnicki
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  2. Ulf Jakobsson
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  3. Pia Teleman
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Correspondence to Martin Rudnicki.

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There were no conflicts of interest for any of the authors.

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The trial was registered at ClinicalTrials.gov: NCT01754558. URL: clinicaltrials.gov/ct2/show/NCT01754558?term=NCT01754558&rank=1

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Rudnicki, M., Jakobsson, U. & Teleman, P. Impact of per-operative antibiotics on the urinary tract infection rate following mid-urethral sling surgery for urinary incontinence: a randomized controlled trial. Int Urogynecol J 31, 1545–1550 (2020). https://doi.org/10.1007/s00192-019-04156-9

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  • DOI: https://doi.org/10.1007/s00192-019-04156-9

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