Association between radical cystectomy prophylactic antimicrobial regimen and postoperative infection

Abstract

Introduction: Infections are common after radical cystectomy. The objective of this study was to determine the association between antimicrobial prophylactic regimen and infection after radical cystectomy.
 Methods: A retrospective cohort study was performed on patients who underwent radical cystectomy at one tertiary Canadian center between January 2016 and April 2020. Patients received antimicrobial prophylaxis based on surgeon preference (cefazolin/metronidazole or ampicillin/ciprofloxacin/metronidazole or other). A univariable and multivariable logistic regression model was created to determine the association between antimicrobial regimen and postoperative infection within 30 days. The association between patient demographic factors, as well as preoperative and intraoperative variables and infection was also determined. Infection characteristics, including type, timing, and antimicrobial susceptibilities were reported.
 Results: One hundred and sixty-five patients were included. Mean age was 69.8 years, 121 (73.3%) were male, and 72 (43.6%) received orthotopic neobladder diversion. Ninety-six patients (58%) received cefazolin/metronidazole prophylaxis, 50 (30%) received ampicillin/ciprofloxacin/metronidazole, and 19 (11.5%) received another regimen. Fifty-four patients (32.7%) developed a postoperative infection (surgical site infection or urinary tract infection). Surgical site infection occurred in 35 patients (21.2%) and urinary tract infection occurred in 34 (21.0%). There was no association between antimicrobial regimen and incidence of postoperative infection (surgical site infection or urinary tract infection, relative risk [RR] 0.99, 95% confidence interval [CI] 0.50–1.99).
 Conclusions: The overall incidence of infection was 32.7% following radical cystectomy. The preoperative prophylactic antibiotic regimen used was not associated with incidence of postoperative infection.

Prevention and management of urinary tract infections after cystectomy

“…Another retrospective cohort study of Ross et al investigated the association between cefazolin/metronidazole or ampicillin/ciprofloxacin/metronidazole, or other and infection after radical cystectomy. The preoperative prophylactic antibiotic regimen used was not associated with incidence of postoperative infection within 30 days [37 ▪ ].…”

A Systematic Review on Postoperative Antibiotic Prophylaxis after Pediatric and Adult Male Urethral Reconstruction

“…However, the data available in the literature on antibiotic prophylaxis in these patients are not consistent in terms of reducing UTIs [25,26]. On the other hand, for many other major surgeries, limiting the duration of perioperative antibiotic prophylaxis is not associated with an increased risk of infectious complications and has a beneficial effect in terms of antimicrobial-associated adverse events [27][28][29]. In the light of the lack of specific recommendations, most urologists performing urethral reconstruction recommend to their patients prolonged antibiotic prophylaxis both during their hospital stay and their subsequent recovery at home [8].…”

Clinical trial: multicentral preventive antibiotics with cystectomy within enhanced recovery after surgery (MACS)

“…При патентном поиске было выявлено множество локальных протоколов АП как способа профилактики инфекционных послеоперационных осложнений. Ведущие урологические сообщества -Европейская Ассоциация урологов (EAU), Американская Ассоциация урологов (AUA) -отмечают три базовых принципа АП при РЦЭ: 1) парентеральное введение антибактериального препарата должно быть выполнено не более, чем за один час до момента разреза; 2) отсутствие разработанной комбинации АБП, поэтому на практике регламентировано использование цефалоспаринов 2-3 поколений или защищенных пенициллинов в течение 24 ч; 3) отсутствует перечень АБП для работы в условиях протокола ERAS, поэтому в хирургических стационарах возможно использовать локальные рекомендации [21]. Поэтому поиск оптимального варианта АП представляет собой практический интерес для выявления и детального изучения факторов риска ранних послеоперационных осложнений.…”