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).
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.
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.
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.
Urologic oncology. 2019 Mar 12 [Epub ahead of print]
Maximilian Haider, Christian Ladurner, Roman Mayr, Zafer Tandogdu, Hans-Martin Fritsche, Vincent Fradet, Evi Comploj, Armin Pycha, Francis Lemire, Louis Lacombe, Yves Fradet, Paul Toren, Michele Lodde
Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany. Electronic address: ., Department of Urology, General Hospital of Bolzano, Bolzano, Italy., Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany., Department of Urology, Northern Institute for Cancer Research, University of Newcastle, Newcastle, United Kingdom., Department of Urology, Chirurgische Klinik München-Bogenhausen, Munich, Germany., Department of Urology, Laval University, Québec, Canada., Department of Urology, General Hospital of Bolzano, Bolzano, Italy; Department of Research, College of Health Care Professions Claudiana, Bolzano, Italy., Department of Urology, General Hospital of Bolzano, Bolzano, Italy; Sigmund Freud Private University, Medical School, Vienna, Austria.