AUA 2016: Prophylactic Antibiotics in the First 30 Days Following Radical Cystectomy with Urinary Diversion Leads to Fewer Urinary Tract Infections - Session Highlights

San Diego, California ( Urinary tract infections account for significant morbidity and hospital readmissions following radical cystectomy with urinary diversion. Both UTIs and readmissions for urinary sepsis typically occur within 30 days of surgery and at the time of stent removal. Dr. Werntz and colleagues sought to evaluate the use of prophylactic antiobiotics in the first 30 days following radical cystectomy.

The authors performed a prospective study of 84 patients undergoing radical cystectomy with urinary diversion as a single institution between 2014-2015. 50% of patients underwent radical cystectomy with urinary diversion without prophylactic antibiotics and 50% of the patients received a urine culture upon hospital discharge and a one month course of prophylactic antibiotics. Both groups had urinary stents in place for 3 weeks postoperatively. All patients were monitored for signs of urinary tract infection and patients with signs or symptoms underwent urine culture.

Patient demographics and disease characteristics were similar between groups. 31% of patients who did not receive prophylactic antibiotics developed a urinary tract infection compared only 11% of those who received one month of antibiotics (p<0.01). There was no association between results of urine culture at discharge and subsequent development of UTI. 7 patients in the non-antibiotic group developed urinary sepsis requiring readmission, while only 1 in the antibiotic treated group did (p= 0.02). RRR of developing a UTI was 97 and NNT to prevent a postoperative UTI was 4.7. RRR of developing urosepsis was 86% and NNT was 6.7.

The authors conclude that a one- month course of prophylactic antibiotics significantly lowers risks for development of UTI following radical cystectomy with urinary diversion. Further, it reduces risks for readmission for urosepsis. Post-operative urine culture was not associated with subsequent development of UTI and therefore unlikely to aid in identifying patients at higher risk for infection.


Presented By: Ryan Werntz, MD

Written By: Simone Vernez; Medical Student, Department of Urology, University of California, Irvine at the 2016 AUA Annual Meeting - May 6 - 10, 2016 – San Diego, California, USA