Association Between Antibiotic Prophylaxis Before Cystectomy or Stent Removal and Infection Complications: A Systematic Review.

Patients undergoing radical cystectomy frequently suffer from infectious complications, including urinary tract infections (UTIs) and surgical site infections (SSIs) leading to emergency department visits, hospital readmission, and added cost.

To summarize the literature regarding perioperative antibiotic prophylaxis, ureteric stent usage, and prevalence of infectious complications after cystectomy.

A systematic review of PubMed/Medline, EMBASE, Cochrane Library, and reference lists was conducted.

We identified 20 reports including a total of 55 306 patients. The median rates of any infection, UTIs, SSIs, and bacteremia were 40%, 20%, 11%, and 6%, respectively. Perioperative antibiotic prophylaxis differed substantially between reports. Perioperative antibiotics were used only during surgery in one study but were continued over several days after surgery in all other studies. Empirical use of antibiotics for 1-3 d after surgery was described in 12 studies, 3-10 d in two studies, and >10 d in four studies. Time to stent removal ranged from 4 to 25 d after cystectomy. Prophylactic antibiotics were used before stent removal in nine of 20 studies; two of these studies used targeted antibiotics based on urine cultures from the ureteric stents, and the other seven studies used a single shot or 2 d of empirical antibiotics. Studies with any prophylactic antibiotic before stent removal found a lower median percentage of positive blood cultures after stent removal than studies without prophylactic antibiotics before stent removal (2% vs 9%).

We confirmed a high proportion of infectious complications after cystectomy, and a heterogeneous pattern of choice and duration of antibiotics during and after surgery or stent removal. These findings highlight a need for further studies and support quality prospective trials.

In this review, we observed wide variability in the use of antibiotics before or after surgical removal of the bladder.

European urology focus. 2023 Jan 27 [Epub ahead of print]

Luca Antonelli, Kirby Sebro, Abdelilah Lahmar, Peter C Black, Saum Ghodoussipour, Jill M Hamilton-Reeves, Jay Shah, Jensen Bente Thoft, Seth Paul Lerner, Carlos Llorente, Ilaria Lucca, Mark A Preston, Sarah P Psutka, John P Sfakianos, Susanne Vahr Lauridsen, Stephen B Williams, James Catto, Hooman Djaladat, Wassim Kassouf, Katherine Loftus, Siamak Daneshmand, Christian D Fankhauser, Enhanced Recovery After Surgery ERAS Cystectomy Committee

Department of Urology, Luzerner Kantonsspital, University of Lucerne, Lucerne, Switzerland; Department of Urology, Policlinico Umberto I, Sapienza University, Rome, Italy., Department of Urology, Western General Hospital, Edinburgh, UK., Medicine, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Oujda, Morocco., Vancouver Prostate Centre and Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada., Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA., Department of Urology, University of Kansas Medical Center, Kansas City, KS, USA., Department of Urology, Stanford University School of Medicine, Stanford, CA, USA., Department of Urology, Aarhus University Hospital, Aarhus, Denmark., Scott Department of Urology, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA., Department of Urology and Research Unit, Hospital Universitario Fundación Alcorcon, Alcorcón, Madrid, Spain., Department of Urology, CHUV, Lausanne, Switzerland., Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Department of Urology, University of Washington, Seattle, WA, USA., Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Department of Urology, Copenhagen University Hospital, Copenhagen, Denmark; WHO-CC, Parker Institute Bispebjerg & Frederiksberg University Hospital, Copenhagen, Denmark., Division of Urology, Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA., Academic Urology Unit, University of Sheffield, Sheffield, UK., Institute of Urology, Kenneth Norris Jr. Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA., Department of Surgery (Urology), Faculty of Medicine, McGill University, Montreal, Quebec, Canada., Department of Anesthesiology, Perioperative and Pain Medicine, Icahn school of Medicine at Mount Sinai, New York, NY, USA., Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA., Department of Urology, Luzerner Kantonsspital, University of Lucerne, Lucerne, Switzerland. Electronic address: .