Intraoperative Only versus Extended Duration Use of Antimicrobial Prophylaxis for Infectious Complications in Radical Cystectomy with Intestinal Urinary Diversion

Abstract

Introduction: In spite of the high incidence of infectious complications (ICs), appropriate duration of antimicrobial prophylaxis (AMP) for radical cystectomy (RC) with intestinal urinary diversion (IUD) has not been established. We compared the incidence of ICs after RC with IUD in patients using only intraoperative AMP or extended duration AMP. Risk factors for ICs were also investigated. Patients and Methods: One hundred twenty-three consecutive patients who underwent RC with IUD were divided into 2 groups based on the AMP duration (intraoperative only vs. extended duration for a median of 3 days). Between the groups, the incidence of ICs was compared. Risk factors for ICs were investigated in multivariate analysis. Results: The IC rate was 44%. No significant difference was found in the rate of ICs between the groups. The IC rate was significantly higher in patients with lower estimated glomerular filtration rate (eGFR). Rates of ICs were 60 and 38% in patients with eGFR of less than 60 and equal or more than 60 mL/min/1.73 m 2 , respectively. Conclusions: Our result indicates that AMP that is administered more than intraoperatively may be excessive in RC with IUD. Patients with a lower eGFR should be particularly cared for postoperative ICs.

Urinary diversions for benign and oncologic indications: what did we learn about short term complications in the last 24 months?

“…The use of antibiotic prophylaxis is recommended in guidelines and widely accepted as a standard of care, yet duration of such prophylactic regimen varies. A recent retrospective analysis of intraoperative only vs extended antibiotic prophylaxis (median 3 days) showed no difference between groups in rates of infectious complications [6]. Still, retrospective analysis with 24-h antibiotic prophylaxis in RC according to an enhanced recovery after surgery (ERAS) protocol found 36% and 7% of the patients developed UTI and urosepsis within 90 days of surgery, respectively [7].…”

“…For example, Tellini et al highlighted smoking as a risk factor in a recent meta-analysis, showing a 34% increase in postoperative infections in the pooled estimate [9 ▪▪ ]. Other reported risk factors for infectious complications include increasing age [10], reduced renal function [6], and continent UD such as orthotopic neobladder (ONB) [11].…”