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Use and duration of antibiotic prophylaxis and the rate of urinary tract infection after radical cystectomy for bladder cancer: Results of a multicentric series.
- Source :
-
Urologic oncology [Urol Oncol] 2019 May; Vol. 37 (5), pp. 300.e9-300.e15. Date of Electronic Publication: 2019 Mar 12. - Publication Year :
- 2019
-
Abstract
- 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).<br />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.<br />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.<br />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.<br /> (Copyright © 2019 Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Bacterial Infections prevention & control
Drug Utilization statistics & numerical data
Female
Humans
Male
Middle Aged
Postoperative Complications microbiology
Postoperative Complications prevention & control
Retrospective Studies
Risk Factors
Time Factors
Urinary Tract Infections microbiology
Urinary Tract Infections prevention & control
Antibiotic Prophylaxis methods
Antibiotic Prophylaxis statistics & numerical data
Bacterial Infections epidemiology
Cystectomy methods
Postoperative Complications epidemiology
Urinary Bladder Neoplasms surgery
Urinary Tract Infections epidemiology
Subjects
Details
- Language :
- English
- ISSN :
- 1873-2496
- Volume :
- 37
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Urologic oncology
- Publication Type :
- Academic Journal
- Accession number :
- 30871997
- Full Text :
- https://doi.org/10.1016/j.urolonc.2019.01.017