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Antibiotic Halves UTI Incidence After Sling Surgery for SUI

Major Finding: A 3-day course of nitrofurantoin given immediately postoperatively to women who had a midurethral sling placed for stress incontinence reduced the incidence of urinary tract infections by almost 50%, compared with placebo.

Data Source: A prospective, randomized, double-blind study of 149 women with stress incontinence who completed 6 weeks of follow-up after placement of a midurethral sling.

Disclosures: Dr. Jackson said he had no relevant financial disclosures.


 

From the Annual Meeting of the American Urogynecologic Society

PROVIDENCE, R.I. – A short course of the urinary antibiotic nitrofurantoin after midurethral sling placement for stress urinary incontinence reduced the incidence of postprocedure urinary tract infection by nearly 50%, reported Dr. Daniel Jackson.

“In the last 10 years, the literature has shown that the incidence of UTIs after sling placement ranges from 8.9% to 34%,” according to Dr. Jackson of the University of Missouri–Columbia.

“We asked whether the incidence of postoperative bladder infection related to midurethral sling placement could be significantly reduced by a short course of a common, inexpensive urinary antibiotic,” he said.

In this prospective, double-blind study, 159 women from two academic medical centers scheduled to undergo outpatient vaginal surgery for stress incontinence were randomized to receive either nitrofurantoin (100 mg twice daily) or placebo for 3 days after surgery.

Data were analyzed from 74 women who received an antibiotic and 75 women who received placebo. All patients received preoperative treatment with a third-generation cephalosporin, Dr. Jackson explained.

At the 6-week visit, a positive diagnosis depended on a positive review of systems for dysuria and frequency and a negative review of systems for vaginal discharge or irritation, as well as a positive urine dip and urine culture, he reported.

Almost one-quarter of women who underwent midurethral sling placement (n = 37/149, 24.8%) were diagnosed with a UTI during the study period.

Treatment with an antibiotic significantly reduced the incidence of UTIs, from 32% in the placebo group to 17.6% in the nitrofurantoin group.

Multivariate analysis indicated that two variables, antibiotic use and no postoperative catheter use, were independently associated with a reduced risk of UTI development, Dr. Jackson commented.

No adverse events were reported in this study.

In response to a question from the audience, Dr. Jackson said that the choice of antibiotic, nitrofurantoin, was based on its cost and his institution's preferences, but he said he had no definitive evidence regarding whether other urinary antibiotics would produce comparable or better results.

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