The timing and frequency of infectious complications after radical cystectomy: an opportunity for rescue antibiotic treatment

Publication date: Available online 15 February 2018Source: Urology PracticeAuthor(s): Brian J. Jordan, Kevin C. Lewis, Richard S. Matulewicz, Shilajit KunduAbstractObjectivesTo evaluate the timing, frequency, and antibiotic sensitivity of post-radical cystectomy (RC) urinary tract infections (UTI) in order to guide an infection reduction initiative.MethodsA combined review of all patients undergoing RC in the 2011-2013 ACS-NSQIP database and 100 consecutive patients from our institution was performed. The rates and timing of postoperative UTI and sepsis in addition to associations with readmissions were evaluated. Specific culture data and treatment interventions were assessed and an institution-specific UTI antibiogram was created.ResultsOf the 3,495 patients identified in NSQIP, the 30-day rates of UTI and sepsis were 9.5% and 9.4%, respectively. Median days to UTI and sepsis were 15 and 13, respectively. Median post-RC length of stay was 10.4 days. A total of 61.5% of UTIs and 52.1% sepsis episodes occurred after discharge. At our institution, the rates of UTI and sepsis were 15% and 9%, and occurred at median of 14 and 18 days, respectively. The 30-day readmission rate was 21%, with 10 readmissions for infections, including 7 for UTI and 5 for bacteremia. We identified 9 patients with positive urine or blood cultures for yeast requiring antifungal therapy. Of the UTIs, 88% were sensitive to oral agents and 79% were sensitive to either nitrofurantoin or ciprofloxacin.
Source: Urology Practice - Category: Urology & Nephrology Source Type: research