Critical appraisal of post-repair nosocomial infection: a trigger for failed repair of urinary fistula

Abstract

Background: Failed fistula repair is an emotive outcome for surgeons and patients. It is usually characterized by anger, frustration and depression. Postoperative urinary tract infection could cause failed repair. Serial urine samples for microscopy, culture and sensitivity with prompt treatment of infection if it exists will usually prevent this unwanted outcome. Objectives: To describe the pattern of nosocomial infection post-urinary fistula repair among women with failed repair. Methods: This was a retrospective review of medical records of women with failed urinary fistula from January to December 2012. Of the 25 patients repaired during the period, patient who had failed repair due to proven microbiological specimen urinary infection were adjudged nosocomial infection. The routine practice is to ensure preoperative sterile urine. The same surgeon performed all the surgeries. Results: Five patients out of the 25 patients operated during the period had evidence of nosocomial infections. The entire urine samples microscopy and culture tests yielded same organism- Klebsiella species; and the sensitivity as well as resistance patterns to antibiotics were the same. We also observed that all women that developed nosocomial infections were nursed on the same ward at the time. Conclusion: Nosocomial infections could negatively influence the outcome of fistula repair. We recommend that attention should be focused beyond the dexterity of the surgeon but also on drivers of post repair nosocomial infections to reduce the occurrence of failed repair. Training of support staff such as nurses in this highly specialized management is imperative including infection control.