1425 URINARY TRACT INFECTION IN PATIENTS WITH AN ORTHOTOPIC NEOBLADDER

Abstract

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion (II)1 Apr 20131425 URINARY TRACT INFECTION IN PATIENTS WITH AN ORTHOTOPIC NEOBLADDER Roy Mano, Hanan Goldberg, Yariv Stabholz, Jack Baniel, Daniel Kedar, and Ofer Yossepowitch Roy ManoRoy Mano Petach Tikva, Israel More articles by this author , Hanan GoldbergHanan Goldberg Petach Tikva, Israel More articles by this author , Yariv StabholzYariv Stabholz Petach Tikva, Israel More articles by this author , Jack BanielJack Baniel Petach Tikva, Israel More articles by this author , Daniel KedarDaniel Kedar Petach Tikva, Israel More articles by this author , and Ofer YossepowitchOfer Yossepowitch Petach Tikva, Israel More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2779AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radical cystectomy with orthotopic neobladder (ONB) urinary diversion is a morbid procedure with a high complication rate. Bacterial infections are the most common early complications, encountered in 24% of patients. We aimed to investigate the incidence, clinical characteristics and predictors of urinary tract infections (UTI) in patients with ONB. METHODS We reviewed the medical records of 79 patients treated with radical cystectomy and ONB urinary diversion between 2004 - 2012. Data pertaining to bacteriuria and clinical UTI after hospital discharge were retrieved. The study endpoints were the incidence and clinical characteristics of bacteriuria, febrile UTI requiring hospital admission and urosepsis. Cumulative incidence of clinical events was assessed with the Kaplan-Meier method. RESULTS The study cohort included 69 males and 10 females at a mean age of 59 ± 8 years. The ONB was constructed with small intestine in 45 (57%) patients, and included a segment of large intestine in 34 (43%). Clean intermittent catheterization was required in 21 (27%) patients early after surgery, most of which resolved over time. Estimated rates of bacteriuria, febrile UTI and urosepsis during follow-up are depicted in figure 1. Bacteriuria was diagnosed in as much as 80% of the patients. Symptomatic urinary tract infection occurred in 36% of the patients during the first 3 month after surgery, but only in 10% and 8% of the patients 3-6 and 6-12 months after surgery, respectively. Common pathogens were Pseudomonas Aeruginosa (22%), E. Coli (22%) and Klebsiella Pneumonia (20%). Overall, 71% of the pathogens were susceptible to Amikacin. On multivariate analysis, age, Charlson comorbidity index, intermittent catheterization, bowel segment used for reconstruction and perioperative chemotherapy treatment did not impact the rates of bacteriuria or clinical UTI. CONCLUSIONS Urinary tract infection after radical cystectomy with ONB is a common complication, occurring usually within the first 3 month after surgery. Pseudomonas aeruginosa is the most commonly involved pathogen. Empirical antibiotic treatment with Amikacin is advised in these cases. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e583-e584 Peer Review Report Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Roy Mano Petach Tikva, Israel More articles by this author Hanan Goldberg Petach Tikva, Israel More articles by this author Yariv Stabholz Petach Tikva, Israel More articles by this author Jack Baniel Petach Tikva, Israel More articles by this author Daniel Kedar Petach Tikva, Israel More articles by this author Ofer Yossepowitch Petach Tikva, Israel More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...