MP06-18 PREVALENCE OF CLOSTRIDIUM DIFFICILE INFECTION IN PATIENTS AFTER RADICAL CYSTECTOMY AND NEOADJUVANT CHEMOTHERAPY

Abstract

You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation II1 Apr 2016MP06-18 PREVALENCE OF CLOSTRIDIUM DIFFICILE INFECTION IN PATIENTS AFTER RADICAL CYSTECTOMY AND NEOADJUVANT CHEMOTHERAPY Katherine Cotter, Owen Aftreth, John Schomburg, Yunhua Fan, and Badrinath Konety Katherine CotterKatherine Cotter More articles by this author , Owen AftrethOwen Aftreth More articles by this author , John SchomburgJohn Schomburg More articles by this author , Yunhua FanYunhua Fan More articles by this author , and Badrinath KonetyBadrinath Konety More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2179AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Clostridium Difficile is the most common cause of nosocomial infectious diarrhea, with a recent prevalence rate of 8.8% described in the post-radical cystectomy population. This study evaluates the prevalence of Clostridium Difficile infections in patients undergoing radical cystectomy who have previously received neoadjuvant chemotherapy. METHODS Retrospective chart review was performed of all patients undergoing radical cystectomy at a single institution from 2011-2015. Infection was diagnosed with the Clostridium Difficile polymerase chain reaction toxin B in the post-operative period. A chi-squared test was used to compare patients who received neoadjuvant chemotherapy with those who only underwent radical cystectomy in order to identify potential risk factors associated with C. Difficile infections. All patients received a standard dose of intravenous antibiotic within 30 minutes of incision. If administered, antibiotic redosing within the 24 hour peri-operative period was documented. RESULTS Of the 133 patients who underwent radical cystectomy, 14 developed Clostridium Difficile in the post-operative period. Median time to diagnosis was 6 days (range 3-28 days) in all patients, with 5.5 days in the post-chemotherapy group and 7.0 in the cystectomy only group. A total of 43 patients received neoadjuvant chemotherapy, and 6/43 (14%) developed C. Difficile infection. A total of 90 patients received neoadjuvant chemotherapy, and 8/90 (9%) developed C. Difficile infection (p=NS). This yielded an overall rate of Clostridium Difficile infection of 105 per 1000 and specifically 139 per 1000 among those undergoing neoadjuvant chemotherapy and 89 per 1000 in those undergoing only radical cystectomy. The rate of infection in patients without NAC was equivalent to the prevalence recorded in the literature (9%), but the prevalence was higher (14%) in patients receiving NAC. Median length of hospital stay was 16 in the post-chemotherapy group and 9 in the cystectomy only group (p=0.08). An association between C. Difficile infection prevalence was not seen with proton pump inhibitor use (p=1.0) or peri-operative antibiotic redosing (p=0.26). CONCLUSIONS The incidence of Clostridium Difficile infection is quite prevalent in patients undergoing radical cystectomy for bladder cancer. The rate of post-operative infection may be higher in those patients who receive neoadjuvant chemotherapy. Judicious use of antibiotics, rapid testing, and prompt therapy can help reduce the morbidity of this infection. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e74 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Katherine Cotter More articles by this author Owen Aftreth More articles by this author John Schomburg More articles by this author Yunhua Fan More articles by this author Badrinath Konety More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...