PREDICTORS OF URINARY TRACT INFECTION AFTER LOWER GASTROINTESTINAL SURGERY
Gianluca Buzzi*1, Maria Antonello1, Ottavia De Simoni2, Federico Scognamiglio1, Gaya Spolverato1, Imerio Angriman1, Pierluigi Pilati2, Salvatore Pucciarelli1, Marco Scarpa1, Ignazio Castagliuolo1
1Chirurgia Generale 3, Azienda Ospedale Universita Padova, Padova, Veneto, Italy; 2Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padova, Veneto, Italy
Background and objectives
Urinary tract infections (UTIs) are a common cause of postoperative morbidity in patients undergoing lower gastrointestinal (GI) surgery that can prolong hospital stays. In patients with a fever of unknown origin (FUO), clinicians do not know what to do while waiting for the results of urocolture. The aims of this study were to identify the predictors of postoperative UTI and to develop a nomogram predicting UTI in the case of postoperative FUO.
Methods
This is an observational, retrospective study, that included all consecutive patients from 1st November 2020 to 1st November 2021 undergoing elective and emergency lower GI surgery at the Chirurgia Generale 3 Unit at the University Hospital of Padua, Italy. The study included 334 patients, 181 male and 153 female, and UTI occurred in 39 (11.7%) of them. UTI was defined by positive urocolture. The analysis was conducted on all 334 surgical patients and then only on patients who had an urocolture done for FUO (95 patients). A nomogram including sex, age, and duration of catheterization was developed to predict the risk of UTI in surgical patients with FUO and was externally validated in 90 consecutive patients undergoing urocolture for FUO at the Chirurgia Oncologica Unit, Veneto Institute of Oncology.
Results
In our explorative cohort, one hundred and nine (N=109) patients performed a urocolture for FUO and thirty-nine were finally diagnosed with UTI (N=39,11.7%). In patients who underwent lower GI surgery, at multivariable analysis, UTI was associated with older age (OR 1.82; CI 1.05 to 3.17; P 0.03), female sex (OR 2.74; CI 1.25 to 5.98; P 0.011), duration of catheterization (OR 1.50; CI 1.22 to 1.87; P <0.001) and the presence of diarrhea (OR 6.62; CI 2.29 to 19.10; P <0.001). In patients who underwent urocolture for FUO, in the multivariate analysis, UTI was associated only with female sex, older age, and duration of catheterization at the date of urocolture. We developed a nomogram for the prediction of UTI in surgical patients with a c-index of 0.76. In the validation cohort, ninety (N=90) consecutive patients, 37 female and 53 male, undergone lower GI surgery underwent urocolture for FUO and were tested with this nomogram. In the validation cohort, the accuracy (c-index) of the nomogram for predicting positive urocolture was 0.71.
Conclusion
UTIs are a common problem in patients undergoing lower GI surgery. A nomogram including the major risk factors may help to reduce the inappropriate use of antibiotics during the period awaiting the result of urocolture. Female sex, older patients and those with diarrhea or long duration of catheterization are particularly at risk for postoperative UTI and should be carefully monitored.
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