Department of Urology, Shinko Hospital, 1-4-47 Wakihama-cho, Chuo-ku, Kobe, Hyogo, 651-0072, Japan.
J Infect Chemother. 2012 Aug;18(4):479-84. doi: 10.1007/s10156-011-0360-9. Epub 2012 Jan 17.
The purpose of this study was to investigate the association between prophylactic antibiotic administration (PAA) and post-operative infection in radical cystectomy with orthotopic neobladder urinary diversion carried out for patients with bladder cancer. Fifty-seven consecutive cases were analyzed retrospectively. Post-operative infections were categorized as urinary tract, wound, and remote infections. We used the antibiotics tazobactam/piperacillin (TAZ/PIPC), sulbactam/ampicillin (SBT/ABPC), flomoxef (FMOX), cefazolin (CEZ), cefotiam (CTM), and cefmetazole (CMZ). Twenty-five (43.9%) patients had post-operative infections. Five of these (8.77%) patients had wound infections, 22 (38.6%) patients had urinary tract infections, and 2 (3.51%) had remote infections. Our statistical analysis demonstrated that the patients with TAZ/PIPC used for PAA (5/18: 27.8%) had a significantly lower post-operative infection rate than patients with other antibiotics (24/39: 61.5%) (p = 0.0442). In addition, the patients with a shorter-duration PAA (within 72 h after the operation (48-72 h)) had a significantly lower rate of post-operative infections (12/33: 36.4%) than those with longer-duration PAA (longer than 72-96 h after the operation) (16/24: 66.7%) (p = 0.0239). Taken together, these results suggest that TAZ/PIPC with shorter PAA duration (within 72 h) might lead to a lower rate of post-operative infections. In conclusion, our data showed that PAA with TAZ/PIPC with a shorter duration PAA (within 72 h) might be recommended for radical cystectomy with orthotopic neobladder reconstruction. A prospective study based on our data is desirable to establish or revise guidelines for prophylactic medication for preventing post-operative infection after radical cystectomy with orthotopic neobladder urinary diversion.
本研究旨在探讨膀胱癌根治性膀胱切除加原位新膀胱尿流改道术预防性应用抗生素（PAA）与术后感染的关系。回顾性分析 57 例连续病例。术后感染分为尿路、伤口和远处感染。我们使用抗生素他唑巴坦/哌拉西林（TAZ/PIPC）、舒巴坦/氨苄西林（SBT/ABPC）、氟莫西沙星（FMOX）、头孢唑林（CEZ）、头孢替坦（CTM）和头孢美唑（CMZ）。25 例（43.9%）患者发生术后感染。其中 5 例（8.77%）为伤口感染，22 例（38.6%）为尿路感染，2 例（3.51%）为远处感染。我们的统计分析表明，接受 PAA 的 TAZ/PIPC 组（5/18：27.8%）的术后感染率明显低于使用其他抗生素的患者（24/39：61.5%）（p = 0.0442）。此外，PAA 持续时间较短（术后 48-72 小时（48-72 小时））的患者术后感染率明显低于 PAA 持续时间较长（术后 72-96 小时）的患者（12/33：36.4%）（16/24：66.7%）（p = 0.0239）。综上所述，这些结果表明，TAZ/PIPC 联合较短的 PAA 持续时间（72 小时内）可能会降低术后感染率。总之，我们的数据表明，对于膀胱癌根治性膀胱切除加原位新膀胱尿流改道术，TAZ/PIPC 联合较短的 PAA 持续时间（72 小时内）可能是一种有效的预防术后感染的方法。基于我们的数据，开展前瞻性研究以建立或修订根治性膀胱切除加原位新膀胱尿流改道术术后预防感染的预防性用药指南是必要的。
