You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness I1 Apr 2014MP6-10 USE AND OUTCOMES OF EXTENDED ANTIBIOTIC PROPHYLAXIS IN UROLOGIC CANCER SURGERY Joshua Calvert, Sarah Holt, Mossanen Matthew, Andrew James, Jonathan Wright, Michael Porter, and John Gore Joshua CalvertJoshua Calvert More articles by this author , Sarah HoltSarah Holt More articles by this author , Mossanen MatthewMossanen Matthew More articles by this author , Andrew JamesAndrew James More articles by this author , Jonathan WrightJonathan Wright More articles by this author , Michael PorterMichael Porter More articles by this author , and John GoreJohn Gore More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.244AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Although perioperative parenteral antibiotic prophylaxis (ABP) prevents postsurgical infectious complications, national guidelines recommend cessation of antibiotics after 24 hours post-procedure. Misuse of antibiotic prophylaxis may contribute to hospital-acquired infections such as Clostridium difficile (C. diff) colitis. The objective is to evaluate practice patterns for ABP in genitourinary cancer surgery and to assess the impact of ABP use on hospital-acquired C. diff infections. METHODS We identified 59,184 patients undergoing radical prostatectomy (RP), 27,921 undergoing partial and radical nephrectomy (Nephx), and 5,425 patients undergoing radical cystectomy (RC) for prostate, kidney, and bladder cancer, respectively, from the Premier Perspectives Database from 2007-2012. We constructed hierarchical linear regression models to identify patient and provider factors associated with inappropriate use of ABP beyond the first postoperative day and we evaluated the association between inappropriate ABP and C. diff infections for patients undergoing Nephx and RC with multivariable logistic regression. RESULTS Surgery-specific multilevel models demonstrated that hospital identity was associated a substantial proportion of the variation in use of extended ABP (35% for RP, 23% for Nephx, 20% for RC). Hispanic ethnicity was associated with extended ABP after RP (OR 1.26, 95%CI 1.06-1.55) and RC (OR 1.92, 95%CI 1.03-3.59). Postoperative C. diff colitis occurred in 0.02% of RP patients, 0.23% of Nephx patients, and 1.7% of RC patients. On multivariable analysis, extended ABP was associated with higher odds of postoperative C. diff infection after Nephx (OR 3.79, 95%CI 2.46-5.84) and RC (OR 1.64, 95%CI 1.12-2.39), independent of other patient and provider characteristics. CONCLUSIONS Antibiotics may be overused after genitourinary cancer surgery and this overuse is associated with hospital-acquired C. diff colitis. Efforts are needed to encourage greater compliance with evidence-based approaches to postoperative care as provider variation explained much of the antibiotic overuse. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e60 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Joshua Calvert More articles by this author Sarah Holt More articles by this author Mossanen Matthew More articles by this author Andrew James More articles by this author Jonathan Wright More articles by this author Michael Porter More articles by this author John Gore More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...