Elective Abdominal Surgery in Patients with UTI
Elective abdominal surgery should be postponed in patients with active urinary tract infection until antimicrobial treatment is completed and symptoms have resolved. 1
Primary Recommendation
Defer all elective procedures when UTI is present until the infection has been adequately treated and clinical improvement is documented. 1 This recommendation is based on clear evidence that proceeding with surgery in the presence of UTI significantly increases postoperative morbidity.
Evidence Supporting Delay
Increased Complication Rates
Patients with preoperative UTI have a 1.5-fold increased risk of overall postoperative complications (OR 1.551,95% CI 1.071-2.247) compared to those without UTI. 2
Both infectious complications (OR 1.515,95% CI 1.000-2.296) and noninfectious complications (OR 1.683,95% CI 1.012-2.799) are significantly elevated when surgery proceeds with active UTI. 2
Even asymptomatic urinary tract colonization carries a 2-fold relative risk of wound complications (36% vs 16%, p < 0.02) in elective orthopedic surgery, suggesting that any urinary tract pathogen presence increases surgical risk. 3
Mechanism of Harm
Preoperative UTI is associated with surgical site infections through hematogenous spread of bacteria from the urinary tract to surgical wounds. 2
The presence of bacteremia or systemic inflammatory response from UTI creates an unfavorable immunologic environment for wound healing and infection control. 2
Pre-Surgical Protocol
Screening Requirements
Obtain urine microscopy (not culture alone) prior to elective abdominal surgery, as bacterial colonization without pyuria may represent contamination rather than true infection. 1
If microscopy suggests infection, obtain urine culture with antimicrobial sensitivities before selecting treatment. 1
Treatment Before Surgery
When UTI is identified, complete a full antimicrobial course directed by culture sensitivities before proceeding with elective surgery. 1
Document symptom resolution clinically before rescheduling the procedure—do not rely solely on repeat cultures, as asymptomatic bacteriuria after treatment may not require further delay. 1
For patients requiring urgent or semi-urgent procedures where delay poses clinical risk, ensure current urine microscopy and cultures with sensitivities are available to guide perioperative antimicrobial selection, recognizing this is treatment rather than prophylaxis. 1
Important Caveats
When Delay May Not Be Feasible
If the surgical indication becomes urgent during UTI treatment (e.g., bowel obstruction, acute abdomen), operative delay becomes unsafe and places patients at higher risk than proceeding with appropriate antimicrobial coverage. 1
In these cases, antimicrobial usage is not prophylactic but therapeutic, requiring assessment of the most probable organisms, their sensitivities, and the antimicrobial's ability to penetrate both the infected urinary site and surgical field. 1
Asymptomatic Bacteriuria Exception
Asymptomatic bacteriuria (ASB) in non-pregnant, low-risk patients may not absolutely require treatment before low-risk procedures where the genitourinary system will not be instrumented. 1
However, single-dose antimicrobial prophylaxis should still be administered regardless of ASB presence when performing intermediate- or higher-risk procedures where mucosal barriers will be broken. 1
Post-Operative UTI Risk
Even with appropriate preoperative management, UTI remains the most frequent healthcare-associated complication after surgery. 4
Implementation of prevention strategies (minimizing catheter duration, early removal) can reduce postoperative UTI incidence from 10.4% to 3.9% (incidence-density ratio 0.41,95% CI 0.20-0.79). 4
Early catheter removal (postoperative day 1 versus day 4) significantly reduces UTI rates (2% vs 14%) without increasing urinary retention risk, even in patients with epidural analgesia. 1