Asymptomatic Bacteriuria and Urological Surgery: Risk Factor or Not? Results from the National and Multicenter TOCUS Database

PURPOSE

Current guidelines recommend screening and treatment of asymptomatic bacteriuria prior to all urological surgeries breaching the mucosa. But few evidence is supporting this recommendation. At least, risk stratification for postoperative urinary tract infection to support this strategy is lacking. The aim of this study was to define the associated factors for postoperative febrile infectious complications (urinary tract infection or surgical site infection) in urological surgery.

MATERIALS AND METHODS

We conducted a retrospective, multicentric study including all consecutive patients undergoing any urological surgery with preoperative urine culture. The primary outcome was the occurrence of a urinary tract infection or surgical site infection occurring within 30 days after surgery.

RESULTS

rom 2016 to 2023, in 10 centers, 2389 patients were included with 838 (35%) positive urine cultures (mono/bi/polymicrobial). Postoperative infections occurred in 106 cases (4.4%), of which 44 had negative urine cultures (41%), 42 had a positive mono/bi-microbial urine cultures (40%) and 20 had a polymicrobial urine cultures (19%). In multivariable analysis, urinary tract infections during the previous 12 months of surgery (OR 3.43; CI 95 2.07-5.66; P < .001), monomicrobial/bimicrobial preoperative urine culture (OR 3.68; CI 95 1.57-8.42; P 0.02), polymicrobial preoperative urine culture (OR 2.85; CI 95 1.52-5.14; P < .001), operative time (OR 1.09; CI 95 1.04-1.15; P < .001) were independent associated factors for postoperative febrile infections.

CONCLUSIONS

Positive urine culture, including preoperative polymicrobial urine culture, prior to urological surgery was associated with postoperative infection. Additionally, patients experiencing infectious complications also had a higher incidence of other complications. The effectiveness of systematic preventive antibiotic therapy for a positive urine culture has not been conclusively established.

Asymptomatic bacteriuria prior to partial and radical nephrectomy: To screen or not to screen? Results from the national and multicenter TOCUS database

INTRODUCTION

In the era of increased bacterial resistance, the main strategy is to reduce the prescription of antibiotics when possible. Nowadays, it is highly recommended to screen for asymptomatic bacteriuria (ABU), prior to urological surgery with potential mucosal breach or urine exposure. Screening and treating urinary colonization is a strategy widely adopted before radical and partial nephrectomy but without any evidence. Our main end point in this study is to analyze the relationship between preoperative urine culture and the risk of postoperative febrile urinary tract infection (UTI) or surgical-site infection (SSI) in partial or radical nephrectomy patients.

METHODS

We conducted a multicenter retrospective cohort study between January 2016 and January 2023 in 11 French tertiary referral hospitals (TOCUS database). We collected the data for 269 patients including several pre-, intra-, and post-operative variables that could potentially increase the risk of postoperative UTI and SSI including preoperative urinary culture results.

RESULTS

The incidence rate of postoperative UTI and SSI was 8.9% in our study. After conducting a logistic multivariate analysis, a propensity score matching analysis, and a subgroup analysis, we found no significant correlation between the urine culture and the postoperative UTI risk [OR = 1.2 (0.5-2.7) (p = 0.7)]. Only the postoperative non-infectious complications were related to a higher risk of postoperative UTI [OR = 12 (4-37), p < 0.001)].

CONCLUSION

Our research shows that screening and treating for ABU prior to radical or partial nephrectomy seems to be unnecessary to prevent postoperative UTI and SSI.