Comparison of the effectiveness of two combinations of antibiotic used for perioperative prophylactic therapy during radical cystectomy: A retrospective cohort study

Abstract

Introduction: This retrospective cohort study aimed to compare primary and secondary outcomes of patients undergoing radical cystectomy according to two different perioperative antimicrobial therapy protocols in 2016. Methods: In this single-center, retrospective cohort study, we investigated data of 104 patients undergoing radical cystectomy due to bladder cancer from January 1, 2016, to December 31, 2016. According to perioperative antimicrobial prophylaxis, patients were divided into two groups: 48 patients received piperacillin/tazobactam 3x4.5 g intravenously (IV) combined with metronidazole 3x500 mg IV, and 56 patients received ceftriaxone 1x2 g IV combined with metronidazole 3x500 mg IV. All patients received the first dose of antibiotics 24 hours prior to the operative procedure, and it continued over the next 48 hours after the procedure. We analyzed and compared data from various primary and secondary outcomes for both groups of patients. Results: In the group of patients receiving the combination of the piperacillin/tazobactam with metronidazole, the length of postoperative hospitalization was shorter (14 vs. 16 days, Z=2.24957 p=0.02383), leukocyte blood count on the first postoperative day was lower (9.80 vs. 11.15, p=0.01384), and hospital-acquired pneumonia was less common (2.08% vs. 12.5%, p=0.04688) than in the group receiving a combination of ceftriaxone and metronidazole. Conclusions: In radical cystectomy, perioperative antimicrobial prophylaxis protocol using piperacillin/tazobactam combined with metronidazole proved to be more effective than the combination of ceftriaxone with metronidazole.

Prevention and management of urinary tract infections after cystectomy

“…A retrospective cohort study of Andrijašević et al analysed the effect of the perioperative (24 h preoperatively and 48 h postoperatively) antimicrobial prophylaxis in patients with bladder cancer after radical cystectomy. This study has shown no statistical difference regarding the postoperative UTI rates between piperacillin/tazobactam 3 × 4.5 g and metronidazole 3 × 500 mg intravenously compared with ceftriaxone 1 × 2 g and metronidazole 3 × 500 mg intravenously [36].…”