Urinary tract infections after pelvic floor gynecological surgery: prevalence and effect of antimicrobial prophylaxis. A systematic review

We evaluated the prevalence of urinary tract infection (UTI) after pelvic floor operations for non-malignant etiology and the effectiveness of antibiotic prophylaxis. This was made possible by a review of the evidence from relevant randomized controlled trials (RCTs). Nineteen out of 879 initially identified studies met the criteria for inclusion in our review. Four RCTs compared an antibiotic prophylactic regimen with placebo, 11 two different prophylactic antibiotic regimens, and four had three different treatment arms. Among placebo recipients undergoing pelvic floor surgery, 10–64% developed UTI. In contrast, UTI after pelvic floor gynecological surgery occurred in 0–15% of the patients who received cephalosporins as antibiotic prophylaxis; the likelihood for postoperative UTI was higher for patients receiving cotrimoxazole (28%), ampicillin/sulbactam (13.6%), metronidazole plus ampicillin (20%), metronidazole (10–22.7%), or ciprofloxacin (27.2%). The use of a cephalosporin as perioperative antimicrobial prophylaxis is the optimal regimen in preventing UTIs after pelvic floor surgery.