Detailed Analysis of Urinary Tract Infections after Robot-Assisted Radical Cystectomy

Urinary tract infections (UTIs) contribute significantly to the morbidity associated with and represent a major cause of readmissions after radical cystectomy, especially within the first month after surgery. UTI occurs in almost 40% of patients after radical cystectomy, with one-third of them occurring within the first 3 months after surgery. Nevertheless, prior studies lacked standardized criteria for what constitutes UTI, and many of them included patients with asymptomatic bacteriuria. In this context, we sought to report a detailed analysis of UTIs after robot-assisted radical cystectomy and better characterize variables associated with UTIs after surgery.

Enterococcus fecalis was the most common causative organism, followed by Escherichia coli, then Klebsiella pneumoniae. The highest antibiotic resistance was observed for penicillin and fluoroquinolones, while the highest sensitivity was observed for aminoglycosides, trimethoprim-sulfamethoxazole, and cefepime. Fungal infections represented 30% of UTIs in the first 30-days after surgery. We found that patients who received neobladders, had longer hospital stays, received adjuvant therapy, developed postoperative hydronephrosis, CKD or ureteroileal anastomotic stricture are at a higher risk of developing UTIs after robot-assisted radical cystectomy. Recent studies suggested that the use of prophylactic antibiotics in the first 30 days following RC was significantly associated with lower UTIs and readmissions from urosepsis after surgery. While it is still controversial whether antibiotic prophylaxis after surgery is needed or not, our data suggest that patients who are at higher risk of UTIs may benefit from postoperative antibiotic prophylaxis.

Written by: Ahmed Aly Hussein, MD, Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA

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