Abstract
Objective: Investigate the microbiology and incidence of drug resistance in patients undergoing TURBT and to identify independent risk factors for UTI following surgery.
 Material & Methods : Retrospective observational study of prospectively collected data of 199 patients who underwent TURBT in a tertiary care center in Mexico City between 2017-2019. Baseline characteristics and microbiological data (frequency of isolated bacteria and antibiotic resistance pattern) were analyzed according to the presence of UTI following surgery. Binary logistic regression analysis was performed to identify independent risk factors for UTI.
 Results: A preoperative positive urine culture (PUC) was present in 28 patients (14%), the most common isolated pathogens were Escherichia coli(48%), Enterococcus faecalis(24%) and Proteus mirabilis(7%). UTI was documented in 20 patients after TURBT (10%), being E. coli(45%) the most common uropathogen which was resistant to Trimethoprim/Sulfamethoxazole(60%) and Ciprofloxacin(40%). Other common isolated pathogens were E. faecalis(27%) and P. mirabilis(9%). There was significant difference in the presence of a PUC before TURBT and necrosis (p=0.001). On the multivariate analysis the PUC before TURBT was associated with UTI after TURBT (OR7.04 [95%CI 2.11-23.29]).
 Limitations: Retrospective study with information limited to the clinical file.
 Originality: There is little information about UTI after TURBT in global literature, in Mexico there is no information, being this study unique in his kind.
 Conclusions: The incidence of UTI after TURBT was 10%. The strongest associated risk factor for UTI after TURBT was a preoperative PUC. The most common isolated uropathogen was E. coli. Trimethoprim/Sulfamethoxazole(60%) and Ciprofloxacin(40%) were the most resistant antibiotics for E. coli.
Highlights
Bladder cancer is the tenth most frequent cancer worldwide, with an estimated incidence of 549,393 new cases in 2018
Transurethral resection of bladder tumor (TURBT) is a common treatment modality in bladder cancer.[3]. It is the main diagnostic and therapeutic tool because it determines stage, as well as tumor grade, as it resects or fulgurates all visible tumors.[4]. Among the most frequent complications of this procedure are infection, bleeding, bladder perforation, and postoperative death.[5,6] Reports in the literature have associated urologic instrumentation with an increase in the incidence of urinary tract infection (UTI) and bacteremia.[7,8] The post-procedure infection rate usually reflects the presence of significant bacteriuria.[6]. There is currently little information about infectious complications associated with TURBT.[9]. The incidence of TURBT-associated UTI has been shown to vary from 18% to 75%(8) and 2% to 39%.(10)
Group 1 included the patients that presented with UTI within the first 30 days after TURBT and group 2 was made up of the patients that did not present with UTI
Summary
Bladder cancer is the tenth most frequent cancer worldwide, with an estimated incidence of 549,393 new cases in 2018. [10,11] Patients with asymptomatic bacteriuria before the procedure have an increased risk of presenting bacteremia and sepsis.[10] There is still no consensus on the use of antibiotic prophylaxis regarding TURBT, despite the fact that it is a frequent procedure.[12].
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