Haider, Maximilian and Ladurner, Christian and Mayr, Roman and Tandogdu, Zafer and Fritsche, Hans-Martin and Fradet, Vincent and Comploj, Evi and Pycha, Armin and Lemire, Francis and Lacombe, Louis and Fradet, Yves and Toren, Paul and Lodde, Michele (2019) Use and duration of antibiotic prophylaxis and the rate of urinary tract infection after radical cystectomy for bladder cancer: Results of a multicentric series. UROLOGIC ONCOLOGY-SEMINARS AND ORIGINAL INVESTIGATIONS, 37 (5): 300.e9. ISSN 1078-1439, 1873-2496
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Objectives: To assess the rate of urinary tract infection (UTI), the characteristics of the bacterial aetiological agents involved, the type and duration of antibiotics used, and the clinical risk factors of UTI in a multi-institutional cohort of patients who had undergone radical cystectomy (RC). Patients and methods: The pre-and postoperative characteristics of patients who had undergone open RC at 1 of 3 institutions between 2009 and 2015 were analyzed by means of the patient charts. Patients were classified according to the presence or absence of UTI. Analysis of the severity of UTI was based on the EAU/EAU Section of Infections in Urology (ESIU) classification system. The bacterial aetiological agents and their antibiotic susceptibility were also assessed. Factors predicting postoperative UTI were identified using univariable and multivariable logistic regression analysis. Results: Of 217 patients, 42 (19.4%) had developed postoperative UTI, of whom 50% had urosepsis or uroseptic shock. Multivariable analysis showed continent urinary derivation as the only significant predictor of UTI with an odds ratio of 5.03 (95% confidence interval 2.12-11.9, P < 0.001). The duration of perioperative antibiotic prophylaxis was not associated with an increased risk of UTI. Enterococcus was the most commonly isolated bacteria (25.7%), but this species is not covered by the recommended antibiotic prophylaxis. Conclusion: Patients with continent urinary diversion after RC have a significantly higher risk of developing UTI. Prolonged perioperative administration of antibiotics does not seem to reduce the risk of UTI. Enterococcus as the most commonly isolated bacteria is not covered by most recommended antibiotic prophylaxis regimens. Therefore different antibiotic regimens should be considered for high-risk patients. (C) 2019 Elsevier Inc. All rights reserved.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | POSTOPERATIVE COMPLICATIONS; ANTIMICROBIAL PROPHYLAXIS; ILEAL; RISK; DIVERSION; Urinary tract infection; Cystectomy; Antibiotic therapy; Urinary diversion; Antibiotic prophylaxis |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Urologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 09 Apr 2020 11:39 |
| Last Modified: | 09 Apr 2020 11:39 |
| URI: | https://pred.uni-regensburg.de/id/eprint/27128 |
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