Asymptomatic Bacteriuria and Urological Surgery: Risk Factor or Not? Results from the National and Multicenter TOCUS Database.

PURPOSE:Current guidelines recommend screening and treatment of asymptomatic bacteriuria prior to all urological surgeries breaching the mucosa. But few evidence is supporting this recommendation. At least, risk stratification for postoperative urinary tract infection to support this strategy is lacking. The aim of this study was to define the associated factors for postoperative febrile infectious complications (urinary tract infection or surgical site infection) in urological surgery. MATERIALS AND METHODS:We conducted a retrospective, multicentric study including all consecutive patients undergoing any urological surgery with preoperative urine culture. The primary outcome was the occurrence of a urinary tract infection or surgical site infection occurring within 30 days after surgery. RESULTS:rom 2016 to 2023, in 10 centers, 2389 patients were included with 838 (35%) positive urine cultures (mono/bi/polymicrobial). Postoperative infections occurred in 106 cases (4.4%), of which 44 had negative urine cultures (41%), 42 had a positive mono/bi-microbial urine cultures (40%) and 20 had a polymicrobial urine cultures (19%). In multivariable analysis, urinary tract infections during the previous 12 months of surgery (OR 3.43; CI 95 2.07-5.66; P < .001), monomicrobial/bimicrobial preoperative urine culture (OR 3.68; CI 95 1.57-8.42; P 0.02), polymicrobial preoperative urine culture (OR 2.85; CI 95 1.52-5.14; P < .001), operative time (OR 1.09; CI 95 1.04-1.15; P < .001) were independent associated factors for postoperative febrile infections. CONCLUSIONS:Positive urine culture, including preoperative polymicrobial urine culture, prior to urological surgery was associated with postoperative infection. Additionally, patients experiencing infectious complications also had a higher incidence of other complications. The effectiveness of systematic preventive antibiotic therapy for a positive urine culture has not been conclusively established.