Perioperative Antibiotic Choice and Urinary Tract Infections in Prolapse Surgery

Importance Urinary tract infections (UTIs) are common yet preventable complications after pelvic organ prolapse (POP) surgery. Objective The objective of this study was to compare hospital-based postoperative UTI rates among patients undergoing POP surgery by perioperative antibiotic regimen received: cefazolin (C), gentamicin + clindamycin (GC), or cefazolin + metronidazole (CM). Study Design This was a retrospective cohort analysis of patients undergoing POP surgery from 2000 to 2022 using a U.S. national database. The primary outcome was UTIs within 30 days postoperatively. Secondary outcomes included emergency department (ED) visits, inpatient admissions, and UTIs within 90 days postoperatively. Inverse probability of treatment weighting (IPTW) was performed to balance on potential confounding preoperative characteristics. Results Of 166,673 POP surgery patients, 3.0% (n=4,953) were diagnosed with a 30-day postoperative UTI. The UTI rate differed by perioperative antibiotic regimen: C 2.9% (n=4,197), CM 2.5% (n=295), and GC 3.8% (n=461), P <0.001. GC was associated with a higher 90-day UTI rate (4.9%, n=601, P <0.001), UTI-related ED visits (1.8%, n=219, P <0.001), and UTI-related hospitalization (0.73%, n=89, P =0.0014) compared with cefazolin-based antibiotic cohorts. After IPTW, cefazolin-based regimens remained associated with decreased odds of postoperative UTI-related complications compared with GC. Compared with cefazolin, GC was associated with increased odds of 30-day UTIs (OR, 1.27; 95% CI, 1.14–1.42), 90-day UTIs (OR, 1.30; 95% CI, 1.18–1.43), UTI-related ED visits (OR, 1.40; 95% CI, 1.19–1.63), and UTI-related inpatient admissions (OR, 1.36; 95% CI, 1.06–1.74). Conclusions Among patients undergoing POP surgery, cefazolin-based antibiotic regimens were associated with a lower probability of hospital-based UTI-related complications compared with the group receiving GC.