Antibiotic Stewardship and Postoperative Infections in Urethroplasties.

ABSTRACT Objective To determine surgical site infection and UTI rates in the setting of urethroplasty. Given significant variation in the utilization of antibiotics, there is an opportunity to improve antibiotic stewardship.  This study aims to elucidate the rate of both UTI and surgical site infection after urethroplasty on a standardized peri-operative antibiotic regimen, and to obtain patient and operative characteristics that may predict infection. Methods We prospectively treated 390 patients undergoing urethroplasty at 11 centers with a standardized peri-operative antibiotic protocol. Patients had a urine culture or urine analysis within 3 weeks of surgery. After surgery, patients were discharged with an indwelling catheter, removed per usual surgeon practice.  All were given nitrofurantoin from discharge until catheter removal. Logistic regression analyses were performed to determine the correlation between patient characteristics or operative categories with post-operative infection. Results The rates of postoperative UTI and wound infection within 30 days were 6.7% and 4.1%, respectively. On multivariate analysis of demographics, comorbidities, and stricture characteristics and repair, only preoperative UTI (p=0.012), history of CAD (p=0.015) and performing a membranous urethroplasty (0.018) were significant predictors of a UTI within 30 days post-operatively.  Location of repair nor graft use increased the risk of UTI. There were no factors predictive of postoperative wound infection. Conclusion A standardized antibiotic protocol was created to narrow and limit excess antibiotic use. This protocol, with clear definitions of UTI and wound infection, allowed determination of accurate infection rates in urethroplasties. Pre-operative UTI, even when properly treated, increases the risk of post-operative UTI.