Urinary Tract Infections After Colorectal Cancer Surgery: Incidence, Microbiology, Antimicrobial Resistance, and Risk Factors
Year: 2026
Type: article
Abstract: Background/Objectives: Postoperative urinary tract infections (UTIs), particularly catheter-associated UTIs (CAUTIs), are potentially preventable complications of colorectal surgery. This study evaluated their incidence, timing, microbiology, antimicrobial resistance, and associated factors among patients undergoing colorectal cancer surgery. Methods: This prospective cohort study included 300 patients undergoing colorectal cancer surgery at a Serbian tertiary hospital. Associations with postoperative UTI, defined according to ECDC criteria, were examined using Firth penalized logistic regression and cause-specific Cox regression, with cumulative catheter exposure modeled as a time-dependent covariate. Results: Nineteen patients (6.3%) developed postoperative UTI, including 17 CAUTIs (89.5%) and two asymptomatic bacteriuria. The incidence rates of all UTIs and CAUTIs were 12.0 (95% confidence interval [CI], 7.2–18.8) and 10.8 (95% CI, 6.3–17.2) per 1000 catheter-days, respectively. Seventeen infections occurred by postoperative day 30, and no additional events occurred after day 45. In the multivariable Firth penalized logistic regression model, cumulative catheter exposure per five catheter-days (adjusted odds ratio [aOR], 1.45; 95% CI, 1.17–1.84), operative duration per 30 min (aOR, 1.59; 95% CI, 1.13–2.21), and preoperative leukocyte count (aOR, 1.20; 95% CI, 1.02–1.42) were associated with UTI. In the primary Cox model, cumulative catheter exposure (adjusted hazard ratio [aHR], 2.66; 95% CI, 2.03–3.50) and operative duration (aHR, 1.60; 95% CI, 1.16–2.21) remained associated with postoperative UTI after adjustment for the other covariates included in the model. Gram-negative organisms predominated, with notable third-generation cephalosporin and carbapenem resistance among Klebsiella–Enterobacter isolates. Conclusions: Most surveillance-defined postoperative UTI events were symptomatic and catheter-associated. Greater cumulative catheter exposure and longer operative duration showed consistent associations with UTI across exploratory models. These findings support careful review of catheter necessity but require confirmation in larger cohorts.
Source: Antibiotics
Language: English
Subfield: Urology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,499
OpenAlex ID: W7225611175