MP21-08 THE USE OF ANTIBIOTIC PROPHYLAXIS IN PATIENTS UNDERGOING RADICAL CYSTECTOMY FOR BLADDER CANCER

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive I1 Apr 2017MP21-08 THE USE OF ANTIBIOTIC PROPHYLAXIS IN PATIENTS UNDERGOING RADICAL CYSTECTOMY FOR BLADDER CANCER Maximilian Haider, Roman Mayr, Hans-Martin Fritsche, Christian Ladurner, Armin Pycha, Evi Comploj, Francis Lemire, Louis Lacombe, Yves Fradet, and Michele Lodde Maximilian HaiderMaximilian Haider More articles by this author , Roman MayrRoman Mayr More articles by this author , Hans-Martin FritscheHans-Martin Fritsche More articles by this author , Christian LadurnerChristian Ladurner More articles by this author , Armin PychaArmin Pycha More articles by this author , Evi ComplojEvi Comploj More articles by this author , Francis LemireFrancis Lemire More articles by this author , Louis LacombeLouis Lacombe More articles by this author , Yves FradetYves Fradet More articles by this author , and Michele LoddeMichele Lodde More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.3270AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Approximately 20-40% of patients after radical cystectomy (RC) suffer from perioperative urinary tract infection (UTI). Guidelines for antimicrobial prophylaxis, such as the AUA Best Practice Statement, are hampered by a lack of RC-specific research and generally based on colorectal surgery literature. METHODS We analyzed RC registries between 2009-2015 from three different urological centers. Baseline variables included i. a. ASA score, TNM-classification and type of urinary diversion. We recorded the presence of urologic devices before RC, neo-adjuvant chemotherapy, previous radiotherapy, prolonged steroids therapy before RC, microbiological urine and blood cultures. UTI was diagnosed according to EAU/ESIU definitions. Primary objective was to analyze the type and length of antibiotic therapy (AB), the percentage and severity of UTIs after RC, the responsible bacteria and their AB sensitivity. We recorded the frequency of CT-scans and invasive procedures after RC and 30-days-readmission rate. RESULTS We analyzed 217 cases of RC. Median length of hospital stay was 13 days (IQR 11-20.5) with 9.2% of the patients still in hospital after 30 days. 30-days-readmission rate was 16.1%. The most frequent AB was a combination of metronidazole (98.2%) with a cephalosporin (89.9%). The median of days of AB administration after RC was 7 days (IQR 5-14). After cessation of the first AB therapy, additional antibiotics were used in 51.6% of the patients. The overall number of UTIs was 42 (19.4%): 9.7% pyelonephritis, 7.8% urosepsis, 1.8% uroseptic shock. Enterococcus spp. was the most frequently isolated bacteria in urine (25.7%) and in blood (42.9%). Enterococcus showed, as awaited, a cephalosporin (100%) and gentamicine (90%) resistance but also a 100% resistance to ciprofloxacin. In univariate logistic regression analysis, age (odds ratio (OR)=0.94; p=0.001), continent derivation (OR=4.36; p<0.001), neoadjuvant chemotherapy (OR=3.07; p=0.044) and the presence of any urologic device before surgery (OR=0.36; p=0.013) were correlated with UTI. In multivariate logistic regression analysis only continent derivation was associated to UTI after surgery (OR=3.16; p=0.010). CONCLUSIONS The UTI rate after RC was 19.4% and in 9.6% of the cases UTI was urosepsis. Continent diversion was the only independent factor associated with a higher risk of UTI but perioperative AB therapy length was not. Enterococci spp. are involved in early infection and not routinely covered by the most common used AB prophylaxes. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e250 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Maximilian Haider More articles by this author Roman Mayr More articles by this author Hans-Martin Fritsche More articles by this author Christian Ladurner More articles by this author Armin Pycha More articles by this author Evi Comploj More articles by this author Francis Lemire More articles by this author Louis Lacombe More articles by this author Yves Fradet More articles by this author Michele Lodde More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...