MP65-13 BROADER SPECTRUM ANTIMICROBIAL PROPHYLAXIS INCLUDING FUNGAL COVERAGE SIGNIFICANTLY REDUCES INFECTIOUS COMPLICATIONS AFTER RADICAL CYSTECTOMY

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive III1 Apr 2015MP65-13 BROADER SPECTRUM ANTIMICROBIAL PROPHYLAXIS INCLUDING FUNGAL COVERAGE SIGNIFICANTLY REDUCES INFECTIOUS COMPLICATIONS AFTER RADICAL CYSTECTOMY Joseph J. Pariser, Blake B. Anderson, Shane M. Pearce, Zhe Han, Benjamin D. Brielmaier, Emily Landon, Jennifer C. Pisano, Gary D. Steinberg, and Norm D. Smith Joseph J. PariserJoseph J. Pariser More articles by this author , Blake B. AndersonBlake B. Anderson More articles by this author , Shane M. PearceShane M. Pearce More articles by this author , Zhe HanZhe Han More articles by this author , Benjamin D. BrielmaierBenjamin D. Brielmaier More articles by this author , Emily LandonEmily Landon More articles by this author , Jennifer C. PisanoJennifer C. Pisano More articles by this author , Gary D. SteinbergGary D. Steinberg More articles by this author , and Norm D. SmithNorm D. Smith More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2303AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radical cystectomy with urinary diversion (RC) carries a significant risk of infectious complications. Guidelines for use of prophylactic antimicrobials are hampered by a lack of evidence and do not include antifungal coverage. Given a relatively high rate of fungal infection and a desire to lower the overall infection rate, we instituted a culture-based preoperative antimicrobial regimen and studied its impact on postoperative infectious complications after RC. METHODS In May 2013, the antimicrobial prophylaxis for patients undergoing RC was changed at our institution after multidisciplinary review of previous positive cultures. Ampicillin-sulbactam 3g + gentamicin 4mg/kg + fluconazole 400mg replaced cefoxitin. Data reviewed for patients who underwent surgery from May 2011 to May 2014 included age, gender, race, BMI, Charlson Comorbidity Index (CCI), smoking status, neoadjuvant chemotherapy, radiation, BCG, diversion type, pathologic stage, robotic approach, OR time and use of TPN. Outcomes of 30 day infectious complications (positive blood culture, UTI, wound infection, abscess, fungal infection and pneumonia) and adverse events (C. diff, readmission and mortality) were compared before and after implementation of the new regimen. Multivariate logistic regression was used to identify independent risk factors for infection while controlling for demographic and clinical factors. RESULTS 258 patients underwent RC before the antibiotic change and 128 patients after for a total of 386 patients. The cohorts were similar in terms of age, gender, race, BMI, smoking, radiation, BCG, diversion, stage, approach, OR time and TPN (all p>0.05). Mean CCI was higher for the latter cohort (3.1 vs 4.2 p<0.01) while neoadjuvant chemo was more common in the earlier cohort (18% vs 9% p=0.03). The overall infection rate decreased with the new regimen (41% vs 30% p=0.04) with decreases in wound (14% vs 6% p=0.02) and fungal (10% vs 3% p=0.02) infections. All other infectious complications and adverse events demonstrated non-significant decreases. Multivariate analysis confirmed that the new regimen was protective against infections (OR=0.58, 95% CI [0.35-0.98] p=0.04) while BMI, increased OR Time, smoking and TPN increased the risk of infections. CONCLUSIONS A change to broader antimicrobial prophylaxis, which was directed and based on institutional cultures to include antifungal coverage, decreased postoperative infectious complications after RC. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e812 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph J. Pariser More articles by this author Blake B. Anderson More articles by this author Shane M. Pearce More articles by this author Zhe Han More articles by this author Benjamin D. Brielmaier More articles by this author Emily Landon More articles by this author Jennifer C. Pisano More articles by this author Gary D. Steinberg More articles by this author Norm D. Smith More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...