Doctor of Nursing Practice
Date of Defense
Problem: The purpose of this project was to determine the most effective prophylactic antibiotic to decrease the number of patients who have urinary tract infections (UTIs) after pelvic floor reconstructive surgery in a gynecological reconstructive surgery practice.
Methods: This was a retrospective chart review from 2015-2017 that included 732 subjects from a single practice. All patients underwent pelvic floor reconstructive surgery, with or without a midurethral sling placed. Patients also had a catheter and vaginal packing postoperatively. Patients who had a culture-proven UTI within the six-week postoperative period were noted.
Results: There were less UTIs (χ2 = 12.119, df = 1, P = .000) in the fluoroquinolone cohort than in the other antibiotic cohort. Additionally, it was found that there was a statistically significant increase in the prevalence of UTIs in those who had amoxicillin clavulanic acid (Augmentin) vs. those who had levofloxacin (Levaquin) (χ2 = 13.102, df = 2, P = .001). Vulvovaginal candidiasis reported symptom findings also proved significant, as the Augmentin cohort had more complaints than any other antibiotic group (χ2 = 30.010, df = 10, P = .001).
Implications: The project findings reinforced the need for prudence when considering prophylactic antibiotic use in the postoperative period. While more research is needed to explore antibiotic treatment options further, the data collected and analyzed provided novel evidence to guide the decrease of unwanted UTIs in this population. Most notably, this project proved Augmentin is not the ideal choice for UTI prophylaxis in this population because of the high number of proven UTIs found, and the statistically high prevalence of vulvovaginal candidiasis-related complaints.
Turnbough, Courtney E., "Prophylactic Antibiotic Use in Female Patients With Pelvic Floor Reconstructive Surgery: A Retrospective Comparative Effectiveness Study" (2018). Dissertations. 779.