Antibiotics for UTI often taken before, after incontinence surgery

By Joanna Lyford, Senior medwireNews Reporter

One in four women undergoing surgery for urinary incontinence has recently taken antibiotics for a urinary tract infection (UTI), a large population-based study shows.

Of the women who had taken antibiotics before surgery, around half used antibiotics again in the 1 year after surgery, a “surprising” finding, according to the study authors.

Rikke Guldberg (University of Southern Denmark, Odense) and team obtained data on 2151 Danish women who underwent surgery for urinary incontinence between 1996 and 2010.

In the year before surgery, 496 (23.1%) of the women had taken antibiotics for a UTI. Women who had used antibiotics were older, on average, than nonusers (60.2 vs 54.2 years) and were more likely to be using oestrogen and to have comorbidities.

After surgery, 26.0% of the women who had previously used antibiotics took them again for a UTI in days 0–60 and 43.3% took them in days 61–365. Among women who had not previously used antibiotics, the respective rates were 11.0% and 14.2%.

In multivariate analysis, women who used antibiotics before surgery were 2.6-fold and 4.5-fold more likely than nonusers to take antibiotics in postoperative days 0–60 and 61–365, respectively.

The only other significant risk factor for postoperative antibiotic use was prior oestrogen therapy, with adjusted odds ratios of 3.3 and 5.2 in days 0–60 and 61–365, respectively.

Writing in BMJ Open, the researchers say that the high proportion of continued antibiotic use for UTIs among women who have undergone incontinence surgery is surprising. It is not explained by recurrent surgery, they say, since only 5% of women in this study underwent a second surgery.

“Possible explanations for the continuing tendency to UTI could be a genetic predisposition for UTI, an anatomic predisposition for UTI, or an increased awareness of UTI for both the women and their doctor”, write Guldberg et al.

Noting that this is the largest and only population-based study to examine the issue of antibiotic use in relation to surgery for urinary incontinence, the authors write: “[I]t would be interesting to assess the use of similar antibiotics in the background population of women to examine whether there is an increased antibiotic burden associated with surgery for [urinary incontinence].”

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