Risk Factors for Postsurgical Uroinfection in Gynecology

Czech version

Authors: I. Čadková ¹; L. Doudová ²; J. Michálek ³; I. Huvar ¹
Authors‘ workplace: Gynekologicko-porodnické oddělení Nemocnice Milosrdných bratří, Brno, primář MUDr. I. Huvar, CSc. ¹; Katedra ekonometrie, Fakulta ekonomiky a managementu, Univerzita obrany, Brno, vedoucí prof. RNDr. Z. Zemánek, CSc. ²; Ústav matematiky, Fakulta strojního inženýrství, VUT Brno, ředitel prof. RNDr. J. Šlapal, CSc. ³
Published in: Ceska Gynekol 2008; 73(4): 241-247

Overview

Objective:
This study eims to evaluate risk factors for postsurgical uroinfection (UTI) in gynecology.

Design:
Clinical retrospective trial.

Setting:
Obstetrics and Gynecology Department, Merciful Brothers Hospital, Brno.

Materials and Methods:
All of 290 women who underwent hysterectomy and/or anterior vaginal repair (with or without anti-incontinence operation) in our hospital during the year 2005 were studied. The following data were noted: age, weight, anamnestic UTI, diabetes, other serious morbidity, moving disorders, estrogene deficiency, the type of surgery, the type of catheter and the duration of its indweling, intra/postoperative complications, urologic symptoms and urine analysis including bacteriology on the 6th postoperative day. There were excluded cases with antibiotic therapy (due to non-urological indications) from the study. The risk factors were assessed on the rest of 262 women, in two subgroups according to the catheter type (Foley/minicatheter), as there were remarcable differences in the indwelling time and other characteristics. „Mini-catheter“ (a thin transurethral catheter) enables spontaneous voiding as well as measuring the postmiction residuum. It was used in case of anterior vaginal repair or Burch operation and extracted as soon as the voiding function had been restored, mostly on the 2nd-3rd day. The Foley was used in the others, mostly for one day. The unidimensional (Fisher and Mann-Whitney test) and multidimensional (logit model, Walds statistic) analyses were performed. The influence of the type of catheter itself was analysed within an indwelling time period (20‑32 hours) in which women of both subgroups were present.

Results:
The Foley group (115 women, indwelling time 16-32 hours) had 3,5% UTI, none of studied factors was estimated as significant. In the mini-catheter group (147 women, catheterisation for 20-234 hours) was 35,4% UTI, with two risk factors: the time of catheterisation (p=0.000029) and complications (p=0.021515). The statistic model we have used (logit analysis) predicts UTI with sensitivity 61,5 and specificity 89,5. There was no difference in the risk of UTI between the two types of used catheters in case of equal time of their insertion.

Conclusion:
Postsurgical UTI was connected significantly with the duration of catheterisation and intra/postoperative complications. In case of short time catheterisation (up to 32 hours), however, the percentage of UTI was low and no risk factor was assessed as significant.

Key words:
UTI (urinary tract infection), CAUTI (catether associated UTI), risk factors, hysterectomy, vaginal prolapse.

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