Antibiotic Choice and Rates of Surgical Site Infections in Prolapse Surgery

Objectives: This study examines the rates of surgical site infections (SSIs) among patients who received guideline-concordant antibiotic regimens undergoing pelvic organ prolapse (POP) surgery using a national U.S. database.

Methods: This is a retrospective cohort study of patients who underwent POP surgery from 2000 to 2020. The primary outcome was any SSI within 30 days of surgery or 90 days of surgery involving mesh. Secondary outcomes included mesh complications and other infectious complications (UTI, sepsis, pneumonia, and sacral osteomyelitis). Multivariable logistic regression and inverse probability of treatment (IPTW) analysis were performed.

Results: Of 130,198 POP surgeries, the unadjusted rate of composite SSI was 1% and differed (p 0.023) across the four most common antibiotic regimens: cefazolin (1%), second generation cephalosporin (0.95%), cefazolin + metronidazole (1.1%), and clindamycin + aminoglycoside (1.4%). After logistic regression, only clindamycin + aminoglycoside was associated with a higher risk of composite SSI (OR 1.37; 95% CI 1.09-1.72) and other infectious outcomes (OR 1.26; 95% CI 1.12-1.42) when compared to cefazolin alone which was affirmed after propensity score matching. Obesity (OR=1.22; 95% CI 1.03-1.43), diabetes without complication (OR=1.30; 95% CI 1.08-1.57), Charlson comorbidity score >0 (OR=1.24; 95% confidence interval 1.06-1.45), and tobacco use (OR=1.22, 95% CI 1.05-1.40) were also predictors of increased composite SSI risk.

Table 1 Unadjusted Complication Rates After POP Surgery by Perioperative Antibiotic Cohort

Table 2 Multivariable Logistic Regression of Composite SSI for POP Surgery

Conclusions: Compared to cefazolin alone, alternative guideline-adherent regimens did not reduce the risk of infectious morbidity, including SSI, after POP surgery in this U.S. national database of patients.