Skip to main content
Log in

Predictors of Postoperative Urinary Tract Infection After Bariatric Surgery

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript



In bariatric surgery patients, urinary tract infections (UTIs) are one of the most common postoperative infections. In this study, we sought to determine if preoperative patient factors and perioperative processes contribute to an increased risk of UTI.


A retrospective analysis was performed of patients who underwent bariatric surgery at a single institution between March 2012 and May 2016. Standard protocol was antibiotic prophylaxis with cefazolin. Patients with a penicillin allergy received clindamycin. Urinary catheters were placed selectively. A univariate and multivariate analyses were performed to determine risk factors for patients who developed a UTI within 30 days postoperatively.


Six hundred ninety-four patients (82.7% female) underwent bariatric surgery in the study interval. UTIs were more common in females (4.9 vs. 1.7%, p = 0.12). On univariate analysis age, operative time, length of stay, urinary catheter placement, clindamycin prophylaxis, and revisional surgery were significantly correlated with UTI. A multivariate logistic regression model revealed the risk of UTI increased 5.38-fold [95% confidence interval (CI) 2.41–12.05] with clindamycin use, 6.37-fold [95% CI 2.22–18.18] with revision surgery, and 1.25-fold [95% CI 1.05–1.49] for every 5 years gained in age.


Older age, clindamycin prophylaxis, and revisional procedures are significantly associated with an increased rate of UTI following bariatric surgery. Several identified variables are modifiable risk factors and targets for a quality improvement initiative to decrease the rate of UTI in bariatric surgery patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others


  1. Klevens RM, Edwards JR, Richards CL, et al. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep. 2007;122(2):160–6.

  2. Saint S. Clinical and economic consequences of nosocomial catheter-related bacteruria. Am J Infect Control. 2000;28(1):68–75.

    Article  CAS  PubMed  Google Scholar 

  3. Weber DJ, Sickbert-Bennett EE, Gould CV, et al. Incidence of catheter-associated and non-catheter-associated urinary tract infections in a healthcare system. Infect Control Hosp Epidemiol. 2011;32(08):822–3.

  4. Chen SY, Stem M, Schweitzer MA, et al. Assessment of post-discharge complications after bariatric surgery: a National Surgical Quality Improvement Program analysis. Surgery. 2015;158(3):777–86.

  5. Foxman B. Urinary tract infection syndromes: occurrence, recurrence, bacteriology, risk factors, and disease burden. Infect Dis Clin N Am. 2014;28(1):1–13.

    Article  Google Scholar 

  6. Saint S, Chenoweth CE. Biofilms and catheter-associated urinary tract infections. Infect Dis Clin N Am. 2003;17(2):411–32.

    Article  Google Scholar 

  7. Trautner BW, Hull RA, Darouiche RO. Prevention of catheter-associated urinary tract infection. Curr Opin Infect Dis. 2005;18(1):37–41.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Jacobsen SM, Stickler DJ, Mobley HLT, et al. Complication catheter-associated urinary tract infections due to Escherichia coli and Proteus mirabilis. Clin Microbiol Rev. 2008;21(1):26–59.

  9. Tambyah PA, Maki DG. Catheter-associated urinary tract infection is rarely symptomatic: a prospective study of 1497 catheterized patients. Arch Intern Med. 2000;160(5):678–82.

    CAS  PubMed  Google Scholar 

  10. Wald HL, Ma A, Bratzler DW, et al. Indwelling urinary catheter use in the postoperative period: analysis of the national surgical infection prevention project data. Arch Surg. 2008;142:551–7.

  11. Alvarez AP, Demzik AL, Alvi HM, et al. Risk factors for postoperative urinary tract infections in patients undergoing total joint arthroplasty. Adv Orthop. 2016; Epub 2016 Nov 28, 2016;1:5.

  12. Mitchell BG, Ferguson JK, Anderson M, et al. Length of stay and mortality associated with healthcare-associated urinary tract infections: a multi-state model. J Hosp Infect. 2016;93(1):92–9.

  13. Semins MJ, Shore AD, Makary MA, et al. The impact of obesity on urinary tract infection risk. Urology. 2012;79(2):266–9.

  14. Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health-Syst Pharm. 2013;70(3):195–283.

  15. Smith BP, Fox N, Fakhro A, et al. “SCIP” ping antibiotic prophylaxis guidelines in trauma. J Trauma Acute Care Surg. 2012;73(2):452–6.

  16. Campagna JD, Bond MC, Schabelman E, et al. The use of cephalosporins in penicillin-allergic patients: a literature review. J Emerg Med. 2012;42(5):612–20.

  17. Bernstein IL, Gruchalla RS, Lee RE, et al. Disease management of drug hypersensitivity: a practice parameter. Ann Allergy Asthma Immunol. 1999;83:665–700.

  18. Sogn DD, Evens R, Shepherd GM, et al. Results of the National Institute of Allergy and Infectious Diseases collaborative clinical trial to test the predictive value of skin testing with major and minor penicillin derivatives in hospitalized patients. Arch Intern Med. 1992;152(5):1025–32.

  19. Wall GC, Peters L, Leaders C, et al. Pharmacist-managed service providing penicillin allergy skin tests. Am J Health Syst Pharm. 2004;61(12):1271–5.

Download references

Author information

Authors and Affiliations



1. Jon C. Gould was responsible for the concept and design of this study. Furthermore, Jon C. Gould takes full responsibility for the integrity of the work as a whole, from inception to published article.

2. Authors Zachary M. Helmen, Melissa C. Helm, and Alexander Nielsen were responsible for acquisition and interpretation of the data.

3. Authors Zachary M. Helmen, Melissa C. Helm, and Alexander Nielsen were responsible for analyzing and interpretation of the data in depth from the statistical point of view.

4. All authors were involved in drafting the manuscript and revising it critically for important intellectual content and have given final approval of the version to be published. Furthermore, all authors have participated sufficiently in the work to take public responsibility for its content.

Corresponding author

Correspondence to Jon C. Gould.

Ethics declarations

Conflict of Interest

JG is a consultant for Torax Medical. The remaining authors declare that they have no competing interests.

Ethical Approval

For this type of study formal consent is not required.

Informed Consent

Does not apply.

Additional information

Presented as a poster at the SAGES 2017 Annual Meeting, Houston, TX, March 2017

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Helmen, Z.M., Helm, M.C., Helm, J.H. et al. Predictors of Postoperative Urinary Tract Infection After Bariatric Surgery. OBES SURG 28, 1950–1954 (2018).

Download citation

  • Published:

  • Issue Date:

  • DOI: