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Published on: August 5, 2010
Prophylactic antibiotics following radical cystectomy reduces urinary tract infections and readmission for sepsis
Ryan P Werntz1, Ann Martinez-Acevedo1, Hamed Amadi1
1Department of Urology, Oregon Health and Science University, Portland, OR.
Insights
Continuous antibiotic prophylaxis significantly reduced urinary tract infections (UTIs) and urosepsis readmissions after radical cystectomy. This approach is crucial for improving patient outcomes post-surgery.
Area of Science:
- Urology
- Surgical Oncology
- Infectious Disease
Background:
- Urinary tract infections (UTIs) and sepsis are significant causes of morbidity within 30 days of cystectomy and urinary diversion.
- Radical cystectomy for bladder cancer necessitates effective strategies to prevent postoperative complications.
Purpose of the Study:
- To evaluate the hypothesis that continuous antibiotic prophylaxis decreases UTIs in the first 30 days following radical cystectomy.
- To assess the impact of a quality initiative aimed at reducing UTIs through antibiotic prophylaxis.
Main Methods:
- Retrospective comparison of 84 patients undergoing radical cystectomy with urinary diversion (42 before and 42 after a quality initiative).
- Antibiotic prophylaxis was administered postoperatively to patients after the initiative.
- Data on UTIs and urosepsis readmissions were collected using chart review and the National Surgical Quality Improvement Program (NSQIP).
Main Results:
- The incidence of UTI was significantly lower in the prophylactic antibiotic group (12%) compared to the no-antibiotic group (36%) (P<0.004).
- Readmissions for urosepsis were also significantly reduced in the antibiotic group (2%) versus the no-antibiotic group (17%) (P = 0.02).
- No UTIs were observed post-stent removal in the prophylaxis group, unlike 30% in the non-prophylaxis group.
Conclusions:
- Continuous antibiotic prophylaxis administered for 30 days post-radical cystectomy is associated with a significant reduction in UTIs.
- This prophylactic strategy also leads to a significant decrease in postoperative readmissions due to urosepsis.
Introduction:
Urinary tract infections (UTI) and sepsis contribute significantly to the morbidity associated with cystectomy and urinary diversion in the first 30 days. We hypothesized that continuous antibiotic prophylaxis decreased UTIs in the first 30 days following radical cystectomy.
Methods:
Patients with urothelial carcinoma of the bladder who underwent a radical cystectomy with urinary diversion for bladder cancer at Oregon Health and Science University from January 2014 to May 2015 were included in the study. The ureteral stents were kept for 3 weeks in both groups. In October 2014, we enacted a Department Quality Initiative to reduce UTIs. Following the initiative, all radical cystectomy patients were discharged home on antibiotic prophylaxis following a postoperative urine culture obtained during hospitalization. To evaluate the effectiveness of the initiative, the last 42 patients before the initiative were compared to the first 42 patients after the initiative with regard to the rate of UTI in the first 30 days following surgery. We used a combination of comprehensive chart review and the American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) to determine UTI and readmission for urosepsis in the first 30 days following surgery. This ensured accurate capture of all patients developing a UTI.
Results:
A total of 12% in the prophylactic antibiotic group had a documented UTI, whereas 36% in the no antibiotic group had a urinary tract infection (P<0.004). A total of 1 (2%) patient in the antibiotic group was readmitted for urosepsis whereas 7 (17%) patients in the no antibiotic group were admitted for urosepsis (P = 0.02). There was no association noted between urine culture at discharge and the development of UTI in the 30-day postdischarge period (P = 0.75). The median time to UTI was 19 days and the most common organism was Enterococcus (32%). Thirty-percent of patients not receiving prophylaxis developed a UTI 1 day after ureteral stent removal. No patients had a UTI following stent removal in the prophylaxis group. No adverse antibiotic related events were noted.
Conclusion:
Prophylactic antibiotics in the 30 days following radical cystectomy is associated with a significant decrease in urinary tract infections and readmission from urosepsis after surgery.
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