Antibiotic prophylaxis is not associated with reduced urinary tract infection-related complications after cystectomy and ileal conduit

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Abstract

Objectives: Majority of complications after ileal conduit urinary diversion with cystectomy are related to urinary tract infections (UTIs). Controversy exists regarding use of prophylactic antibiotics after surgery. We determined if prophylactic antibiotic use during ureteral stent placement after ileal conduit urinary diversion decreased incidence of UTI-related complications.

Methods: We retrospectively identified 75 consecutive patients who underwent ileal conduit urinary diversion with cystectomy at our institution from 2010 to 2016. Patients were stratified based on presence or absence of a UTI-related complication in the 90-day postoperative period. Means were compared with independent t-test and proportions with chi-square analysis. Multivariate logistic regression was performed to determine independent predictors of UTI-related complications.

Results: Forty-five patients (60%) were prescribed prophylactic antibiotics after surgery. Mean duration of antibiotic use was 15 d, and mean duration of ureteral stenting was 25 d. Most common antibiotics used included fluoroquinolones (n = 23, 30.7%) followed by sulfamethoxazole-trimethoprim (n = 14, 18.7%). Rate of 90-day UTI-related complications was 36% (n = 27), and 90-day UTI-related readmission rate was 14.7% (n = 11). On bivariate and multivariate analysis, prophylactic antibiotic use was not associated with reduced 90-day UTI-related complications (P > 0.05). Patients prescribed prophylactic antibiotics had increased incidence of Clostridium difficile infections in the 90-day postoperative period compared to controls (20% vs. 3.3%; P = 0.038).

Conclusions: Prophylactic antibiotic use after ileal conduit urinary diversion with cystectomy was not associated with reduced UTI-related complications, and rate of Clostridium difficile infections was higher in this patient cohort. The effect of early removal of ureteral stents on UTI risk still has to be elucidated.

Keywords

cystectomy

ileal conduit

urinary tract infection

complications

antibiotics

References

1. Shariat SF, Karakiewicz PI, Palapattu GS, Lotan Y, Rogers CG, Amiel GE, et al. Outcomes of radical cystectomy for transitional cell carcinoma of the bladder: a contemporary series from the Bladder Cancer Research Consortium. J Urol. 2006;176(6 Pt 1):2414-22; discussion 22. doi: 10.1016/j.juro.2006.08.004. PubMed PMID: 17085118.
2. Collaboration ABCM-a. Neoadjuvant chemotherapy in invasive bladder cancer: a systematic review and meta-analysis. Lancet. 2003;361(9373):1927-34. PubMed PMID: 12801735.
3. Estape R, Mendez LE, Angioli R, Penalver M. Urinary diversion in gynecologic oncology. Surg Clin North Am. 2001;81(4):781-97. PubMed PMID: 11551125.
4. Petros JG, Augustinos P, Lopez MJ. Pelvic exenteration for carcinoma of the colon and rectum. Semin Surg Oncol. 1999;17(3):206-12. PubMed PMID: 10504669.
5. Kaefer M, Tobin MS, Hendren WH, Bauer SB, Peters CA, Atala A, et al. Continent urinary diversion: the Children's Hospital experience. J Urol. 1997;157(4):1394-9. PubMed PMID: 9120962.
6. Chang SS, Cole E, Smith JA, Cookson MS. Pathological findings of gynecologic organs obtained at female radical cystectomy. J Urol. 2002;168(1):147-9. PubMed PMID: 12050510.
7. Ali-El-Dein B, Gomha M, Ghoneim MA. Critical evaluation of the problem of chronic urinary retention after orthotopic bladder substitution in women. J Urol. 2002;168(2):587-92. PubMed PMID: 12131315.
8. Madersbacher S, Schmidt J, Eberle JM, Thoeny HC, Burkhard F, Hochreiter W, et al. Long-term outcome of ileal conduit diversion. J Urol. 2003;169(3):985-90. doi: 10.1097/01.ju.0000051462.45388.14. PubMed PMID: 12576827.
9. Farnham SB, Cookson MS. Surgical complications of urinary diversion. World J Urol. 2004;22(3):157-67. Epub 2004/08/13. doi: 10.1007/s00345-004-0429-5. PubMed PMID: 15316737.
10. Kouba E, Sands M, Lentz A, Wallen E, Pruthi RS. Incidence and risk factors of stomal complications in patients undergoing cystectomy with ileal conduit urinary diversion for bladder cancer. J Urol. 2007;178(3 Pt 1):950-4. Epub 2007/07/16. doi: 10.1016/j.juro.2007.05.028. PubMed PMID: 17632147.
11. Stroumbakis N, Herr HW, Cookson MS, Fair WR. Radical cystectomy in the octogenarian. J Urol. 1997;158(6):2113-7. PubMed PMID: 9366325.
12. Clark PE, Stein JP, Groshen SG, Cai J, Miranda G, Lieskovsky G, et al. Radical cystectomy in the elderly: comparison of clincal outcomes between younger and older patients. Cancer. 2005;104(1):36-43. doi: 10.1002/cncr.21126. PubMed PMID: 15912515.
13. Brown KA, Khanafer N, Daneman N, Fisman DN. Meta-analysis of antibiotics and the risk of community-associated Clostridium difficile infection. Antimicrob Agents Chemother. 2013;57(5):2326-32. Epub 2013/03/11. doi: 10.1128/AAC.02176-12. PubMed PMID: 23478961; PubMed Central PMCID: PMCPMC3632900.
14. Garcia-Garcia ML, Martin-Lorenzo JG, Liron-Ruiz R, Torralba-Martinez JA, Garcia-Lopez JA, Aguayo-Albasini JL. Perioperative complications following bariatric surgery according to the clavien-dindo classification. Score validation, literature review and results in a single-centre series. Surg Obes Relat Dis. 2017;13(9):1555-61. doi: 10.1016/j.soard.2017.04.018. PubMed PMID: 28601534.
15. Barie PS. Guidelines for antimicrobial prophylaxis in surgery: a must-read, must-heed for every surgeon. Surg Infect (Larchmt). 2013;14(1):5-7. doi: 10.1089/sur.2013.9995. PubMed PMID: 23488693.
16. Hara N, Kitamura Y, Saito T, Komatsubara S, Nishiyama T, Takahashi K. Perioperative antibiotics in radical cystectomy with ileal conduit urinary diversion: efficacy and risk of antimicrobial prophylaxis on the operation day alone. Int J Urol. 2008;15(6):511-5. Epub 2008/04/14. doi: 10.1111/j.1442-2042.2008.02050.x. PubMed PMID: 18422576.
17. Werntz RP, Martinez-Acevedo A, Amadi H, Kopp R, La Rochelle J, Koppie T, et al. Prophylactic antibiotics following radical cystectomy reduces urinary tract infections and readmission for sepsis from a urinary source. Urol Oncol. 2018. Epub 2018/01/12. doi: 10.1016/j.urolonc.2017.12.025. PubMed PMID: 29338914.
18. Krasnow RE, Mossanen M, Koo S, Kubiak DW, Preston MA, Chung BI, et al. Prophylactic Antibiotics and Postoperative Complications of Radical Cystectomy: A Population Based Analysis in the United States. J Urol. 2017;198(2):297-304. Epub 2017/03/04. doi: 10.1016/j.juro.2017.02.3340. PubMed PMID: 28267603.
19. Davies BJ, Allareddy V, Konety BR. Effect of postcystectomy infectious complications on cost, length of stay, and mortality. Urology. 2009;73(3):598-602. Epub 2009/01/23. doi: 10.1016/j.urology.2008.09.080. PubMed PMID: 19167035.
20. Shabeena KS, Bhargava R, Manzoor MAP, Mujeeburahiman M. Characteristics of bacterial colonization after indwelling double-J ureteral stents for different time duration. Urol Ann. 2018;10(1):71-5. doi: 10.4103/UA.UA_158_17. PubMed PMID: 29416279; PubMed Central PMCID: PMCPMC5791462.

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