Impact of positive preoperative E. coli infection on surgical site infection and postoperative fever after urethral strictoplasty

Abstract

Objective To investigate whether E. coli infection increases surgical site infection and postoperative fever in comparison with other pathogens. Methods A retrospective cohort study was conducted on 506 patients who underwent urethral segment resection and end anastomosis for the bulb or posterior urethral stenosis in our department during 2011 and 2019. According to occurrence of postoperative surgical site infection (SSI) or postoperative fever (POF), they were divided into SSI group (n=19) and non-SSI group (n=487), as well as POF group (n=61) and non-POF group (n=445 patients) respectively. Multivariate logistic regression analysis and LASSO algorithm were used to screen the potential risk factors. According to the results of positive preoperative urine culture in 302 patients, they were subsequently divided into E. coli infection group (n=80) and other pathogen infection group (n=222), and after reducing potential bias with propensity score matching, finally 48 patients were assigned into E. coli infection group, and 192 into other pathogen infection groups. The differences in occurrences of SSI and POF were compared between the above 2 groups of patients. Results Multivariate logistic regression analysis and LASSO algorithm revealed that positive preoperative urine culture was an independent risk factor for predicting SSI (P=0.012) and POF (P<0.01). Among the 302 patients with positive results in preoperative urine culture, E. coli infections was in the first rank, accounting for 26.5%. After propensity score matched treatment, the incidence of SSI in the E. coli group and other pathogen groups was 29.2% and 2.1%, respectively (P<0.01). The incidence of POF was also higher in the E. coli infection group than the other pathogen infection group (27.1% vs 13.5%, P=0.02). Conclusion Preoperative E. coli infection may increase the risk of SSI and POF after urethroplasty when compared with other pathogen infections.

Keywords

• urethroplasty
• urethral stricture
• surgical site infection
• risk factors