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Urinary tract infection prevention after midurethral slings in pelvic floor reconstructive surgery: A systematic review and meta-analysis.
Acta Obstet Gynecol Scand. 2019 12; 98(12):1514-1522.AO

Abstract

INTRODUCTION

Synthetic midurethral slings are the most common procedures currently performed for stress urinary incontinence in women. Infection is a frequent complication of urogynecologic surgery. We performed a systematic review and meta-analysis to identify interventions that successfully prevent infections, including urinary tract infection (UTI) and/or bacteriuria, compared with no intervention, in women undergoing midurethral sling surgery with or without concomitant pelvic reconstructive procedures for prolapse.

MATERIAL AND METHODS

The primary outcome was the development of any infection post-midurethral sling placement in women. MEDLINE, Embase, CINAHL and the Cochrane Library were searched for comparative studies from inception to July 2017, with no language restrictions. We used search terms related to midurethral sling, infections and infection-reduction interventions. Two independent reviewers abstracted data and assessed study quality. Pooled effect size estimates were calculated. We conducted meta-analysis of eligible studies. A protocol for this review has been registered and can be accessed online (http://hdl.handle.net/2429/64731).

RESULTS

We identified seven eligible studies of infection risk-reducing interventions; all focused on UTIs. Only one study assessed preoperative antibiotics with midurethral sling alone and was halted early because of low UTI rates. All other studies (three randomized control trials and three observational studies) examined whether postoperative antibiotics decrease UTI/bacteriuria rates after midurethral sling with or without reconstructive procedures for pelvic organ prolapse and using bladder catheterization postoperatively. Due to considerable clinical heterogeneity, we only combined four studies for meta-analysis. Postoperative oral prophylactic nitrofurantoin showed no significant benefit in reducing UTI/bacteriuria in women post-midurethral sling with or without concomitant reconstructive pelvic surgery and the need for bladder catheterization, when compared with the reference group (pooled relative risk 0.73, 95% confidence interval [CI] 0.42-1.25).

CONCLUSIONS

Based on the best available evidence, postoperative oral nitrofurantoin is not effective at reducing UTI/bacteriuria rates in catheterized women after midurethral sling with or without concomitant pelvic reconstructive surgery for prolapse. For midurethral sling alone, preoperative antibiotic prophylaxis may not be needed for UTI prevention.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada. Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB, Canada.Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada.Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada.Woodward Library, University of British Columbia, Vancouver, BC, Canada.Center for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, BC, Canada.Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada. Center for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, BC, Canada.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

31112286

Citation

Sanaee, May S., et al. "Urinary Tract Infection Prevention After Midurethral Slings in Pelvic Floor Reconstructive Surgery: a Systematic Review and Meta-analysis." Acta Obstetricia Et Gynecologica Scandinavica, vol. 98, no. 12, 2019, pp. 1514-1522.
Sanaee MS, Hutcheon JA, Larouche M, et al. Urinary tract infection prevention after midurethral slings in pelvic floor reconstructive surgery: A systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2019;98(12):1514-1522.
Sanaee, M. S., Hutcheon, J. A., Larouche, M., Brown, H. L., Lee, T., & Geoffrion, R. (2019). Urinary tract infection prevention after midurethral slings in pelvic floor reconstructive surgery: A systematic review and meta-analysis. Acta Obstetricia Et Gynecologica Scandinavica, 98(12), 1514-1522. https://doi.org/10.1111/aogs.13661
Sanaee MS, et al. Urinary Tract Infection Prevention After Midurethral Slings in Pelvic Floor Reconstructive Surgery: a Systematic Review and Meta-analysis. Acta Obstet Gynecol Scand. 2019;98(12):1514-1522. PubMed PMID: 31112286.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Urinary tract infection prevention after midurethral slings in pelvic floor reconstructive surgery: A systematic review and meta-analysis. AU - Sanaee,May S, AU - Hutcheon,Jennifer A, AU - Larouche,Maryse, AU - Brown,Helen L, AU - Lee,Terry, AU - Geoffrion,Roxana, Y1 - 2019/06/20/ PY - 2019/02/23/received PY - 2019/05/05/accepted PY - 2019/5/22/pubmed PY - 2020/3/31/medline PY - 2019/5/22/entrez KW - antibiotic prophylaxis KW - infection prevention KW - midurethral sling KW - pelvic floor reconstruction KW - stress urinary incontinence KW - surgical site infection KW - urinary tract infection SP - 1514 EP - 1522 JF - Acta obstetricia et gynecologica Scandinavica JO - Acta Obstet Gynecol Scand VL - 98 IS - 12 N2 - INTRODUCTION: Synthetic midurethral slings are the most common procedures currently performed for stress urinary incontinence in women. Infection is a frequent complication of urogynecologic surgery. We performed a systematic review and meta-analysis to identify interventions that successfully prevent infections, including urinary tract infection (UTI) and/or bacteriuria, compared with no intervention, in women undergoing midurethral sling surgery with or without concomitant pelvic reconstructive procedures for prolapse. MATERIAL AND METHODS: The primary outcome was the development of any infection post-midurethral sling placement in women. MEDLINE, Embase, CINAHL and the Cochrane Library were searched for comparative studies from inception to July 2017, with no language restrictions. We used search terms related to midurethral sling, infections and infection-reduction interventions. Two independent reviewers abstracted data and assessed study quality. Pooled effect size estimates were calculated. We conducted meta-analysis of eligible studies. A protocol for this review has been registered and can be accessed online (http://hdl.handle.net/2429/64731). RESULTS: We identified seven eligible studies of infection risk-reducing interventions; all focused on UTIs. Only one study assessed preoperative antibiotics with midurethral sling alone and was halted early because of low UTI rates. All other studies (three randomized control trials and three observational studies) examined whether postoperative antibiotics decrease UTI/bacteriuria rates after midurethral sling with or without reconstructive procedures for pelvic organ prolapse and using bladder catheterization postoperatively. Due to considerable clinical heterogeneity, we only combined four studies for meta-analysis. Postoperative oral prophylactic nitrofurantoin showed no significant benefit in reducing UTI/bacteriuria in women post-midurethral sling with or without concomitant reconstructive pelvic surgery and the need for bladder catheterization, when compared with the reference group (pooled relative risk 0.73, 95% confidence interval [CI] 0.42-1.25). CONCLUSIONS: Based on the best available evidence, postoperative oral nitrofurantoin is not effective at reducing UTI/bacteriuria rates in catheterized women after midurethral sling with or without concomitant pelvic reconstructive surgery for prolapse. For midurethral sling alone, preoperative antibiotic prophylaxis may not be needed for UTI prevention. SN - 1600-0412 UR - https://www.unboundmedicine.com/medline/citation/31112286/Urinary_tract_infection_prevention_after_midurethral_slings_in_pelvic_floor_reconstructive_surgery:_A_systematic_review_and_meta_analysis_ L2 - https://doi.org/10.1111/aogs.13661 DB - PRIME DP - Unbound Medicine ER -