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

Autor: A.G. Van Der Heijden, Eva Kolwijck, A. E. M. Seegers, Sofie C. M. Tops, J. ten Oever, J. P. M. Sedelaar
Rok vydání: 2019
Předmět:
Male
0301 basic medicine
medicine.medical_treatment
Ureteral stent
Antibiotics
Cefazolin
lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4]
Bacteremia
0302 clinical medicine
Postoperative Complications
Ureteral Diseases
030212 general & internal medicine
Antibiotic prophylaxis
Post operative
Antiinfective agent
Incidence
Incidence (epidemiology)
Middle Aged
Anti-Bacterial Agents
3. Good health
Ureteral stent removal
Infectious Diseases
Urinary Tract Infections
Female
Gentamicin
Stents
medicine.drug
Research Article
Adult
medicine.medical_specialty
medicine.drug_class
Urology
030106 microbiology
Cystectomy
Microbiology
lcsh:Infectious and parasitic diseases
03 medical and health sciences
Enterobacteriaceae
Metronidazole
Urological cancers Radboud Institute for Molecular Life Sciences [Radboudumc 15]
medicine
Humans
lcsh:RC109-216
Aged
Retrospective Studies
business.industry
Post-operative infection
Retrospective cohort study
medicine.disease
Surgery
Radical cystectomy
Logistic Models
lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4]
business
Zdroj: BMC Infectious Diseases, 19
BMC Infectious Diseases, Vol 19, Iss 1, Pp 1-8 (2019)
BMC Infectious Diseases
ISSN: 1471-2334
Popis: Background Post-operative infections are frequent after radical cystectomy with urinary diversion surgery (UDS). Reduction of post-operative infections necessitates appropriate peri-operative antimicrobial prophylaxis targeting causative bacteria. We assessed the incidence and microbiology of infections in the 30-day post-operative period after UDS and investigated effectiveness of the currently used peri-operative antibacterial prophylaxis. Methods Retrospective cohort study of all patients undergoing UDS in a tertiary university medical center from January 2014 until September 2016. Antibiotic prophylaxis consisted of cefazolin plus metronidazol according to the Dutch national guideline. Primary outcome was the incidence of post-operative infections within 30 days. Risk factors for post-operative infections and antimicrobial susceptibility profiles of cultured bacteria were also assessed. Results 147 patients were included. 69 patients (46.9%) had 82 post-operative infections, 27 of which were patients with bacteremia (18.4%). Highest incidence of infections was on day 4–5 and on day 8–10 postoperatively. The second peak was associated with ureteral stent removal. 4.8% of 147 study patients developed bacteremia 24 h after stent removal, which counted for 25.9% of all bacteremia episodes found in this study. Enterobacteriaceae were cultured in 67.9% of blood cultures and were only highly susceptible to ciprofloxacine, piperacillin-tazobactam (90%), meropenem and gentamicin (100%). Multivariate logistic regression analysis showed orthotopic Hautmann neobladder to be associated with increased infections complications: odds ratio 4.1 (95% confidence interval 1.6–10.5), p = 0.03. Conclusions The incidence of infections after radical cystectomy is high and particularly ureteral stent removal was associated with both bacteremia and complicated urinary tract infections. Based on the results of this study, antibiotic prophylaxis might need to be broadened for patients undergoing radical cystectomy. Further research is required to investigate whether current guidelines need to be altered concerning administration of antibiotic prophylaxis just before stent removal. Electronic supplementary material The online version of this article (10.1186/s12879-019-3932-4) contains supplementary material, which is available to authorized users.
Databáze: OpenAIRE
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