Febrile Urinary Tract Infection after Radical Cystectomy and Ileal Neobladder in Patients with Bladder Cancer

Abstract

Urinary tract infection (UTI) is one of the most common complications after radical cystectomy and orthotopic neobladder reconstruction. This study investigated the incidence and implicated pathogen of febrile UTI after ileal neobladder reconstruction and identify clinical and urodynamic parameters associated with febrile UTI. From January 2001 to May 2015, 236 patients who underwent radical cystectomy and ileal neobladder were included in this study. Fifty-five episodes of febrile UTI were identified in 46 patients (19.4%). The probability of febrile UTI was 17.6% and 19.8% at 6 months and 24 months after surgery, respectively. While, Escherichia coli was the most common implicated pathogen (22/55, 40.0%), Enterococcus spp. were the most common pathogen during the first month after surgery (18/33, 54.5%). In multivariate logistic regression analysis, ureteral stricture was an independent risk factor associated with febrile UTI (OR 5.93, P = 0.023). However, ureteral stricture accounted for only 6 episodes (10.9%, 6/55) of febrile UTI. Most episodes of febrile UTI occurred within 6 months after surgery. Thus, to identify risk factors associated with febrile UTI in the initial postoperative period, we assessed videourodynamics within 6 months after surgery in 38 patients. On videourodyamic examination, vesicoureteral reflux (VUR) was identified in 16 patients (42.1%). The rate of VUR presence in patients who had febrile UTI was not significantly different from those in patients without febrile UTI (50% vs. 39.3%, P = 0.556). Patients with febrile UTI had significantly larger residual urine volume (212.0 ± 193.7 vs. 90.5 ± 148.2, P = 0.048) than those without. E. coli and Enterococcus spp. are common pathogens and ureteral stricture and residual urine are risk factors for UTI after ileal neobladder reconstruction.

Prevalence of Asymptomatic Bacteriuria and Antibiotic Susceptibility Patterns of Bacterial Isolates among Cancer Patients and Healthy Blood Donors at the University of Gondar Specialized Hospital

“…In this study, the overall prevalence of asymptomatic bacteriuria in cancer confirmed patients was 23.3%. is finding of bacteriuria was in line with the reports in Korea (23.5%) [26] and India (20.1%) [27]. However, a higher prevalence of bacteriuria was reported in this study than the studies conducted in Texas (15%), Sweden (5%), and Japan (15%) [28][29][30].…”

“…In our study, catheterization and previous surgery and other independent variables were not significantly associated with bacteriuria. Consistently, surgery had been found to be less important in a study by Kim et al in patients with bladder cancer [41]. In our study, the effect of ampicillin, augmentin, tetracycline, and penicillin were minimal while cefoxitin, International Journal of Microbiology nitrofurantoin, norfloxacin, nalidixic acid, and ciprofloxacin were found to be the most efficient antibiotics for bacterial isolates from both cancer patients and apparently healthy blood donors.…”

Incidence and microbiology of post-operative infections after radical cystectomy and ureteral stent removal; a retrospective cohort study

“…Rates of early post-operative bacteremia, SSI and UTI (< 30 days) in other studies varied between 5 to 17%, 8 to 33% and 4 to 36%, respectively. [5, 9–11] One explanation for the large differences in reported incidences of post-operative infections after radical cystectomy might be the different types of antibiotic prophylaxis regimens used in different studies. Pariser et al showed that type of peri-operative antibiotic prophylaxis regimen might have significant effect on infection outcomes after radical cystectomy [7], which was also found in two other studies that analyzed post-operative infections within 90 days after UDS [14, 23].…”

“…Of these infectious complications, bacteremia was reported in 5 to 17% of the patients [9–11], cUTI was reported in 4 to 36% of the patients [5, 9–11] and SSI was reported in 8 to 33% of patients [4, 6–9, 11] after UDS, even when peri-operative antimicrobial prophylaxis was used. Although some of these studies reported on the causative bacteria [4, 5, 8–10], we found that only a few studies partially provided information on antimicrobial susceptibility of the cultured bacteria [4, 8, 9]. Particularly in the era of increasing antimicrobial resistance, susceptibility profiles provide an important pillar in the correct use of antimicrobial prophylaxis [7, 12].…”

Impact of a change in duration of prophylactic antibiotics on infectious complications after radical cystectomy with a neobladder

“…The IONB was constructed using the Studer technique; the surgical procedure was described previously. [13] Ultimately, 287 patients with a Studer IONB after RC were analyzed.…”