Shigemura Katsumi, Tanaka Kazushi, Hamasuna Ryoichi, Ishikawa Kiyohito, Matsumoto Tetsuro, Arakawa Soichi, Kiyota Hiroshi, Yamamoto Shingo, Fujisawa Masato
Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan,
Department of Infection Control and Prevention, Kobe University Hospital, Kobe, Japan,
Urol Int. 2019;102(3):293-298. doi: 10.1159/000496209. Epub 2019 Feb 18.
The purpose of this study was to investigate the association between prophylactic antibiotic administration (PAA) and postoperative infection after radical cystectomy with urinary diversion in patients with invasive bladder cancer.
Forty-nine consecutive cases were analyzed prospectively. Postoperative infections were categorized as surgical site infection (SSI) and remote infection (RI). We used the antibiotics tazobactam/piperacillin (TAZ/PIPC) as PAA (48 h).
A total of 18 (36.7%) patients had postoperative infections, 4/18 (22.2%) patients had wound infections, and 12/18 (66.7%) patients had RI. In the risk factor study for SSI and RI occurrences, we found that the surgical time was significantly shorter in the non-infection group (p = 0.031). Taken together, these results suggest that TAZ/PIPC with shorter PAA duration (48 h) might lead to a lower rate of postoperative infections.
Our data showed that PAA with TAZ/PIPC with a shorter duration PAA (48 h) might be recommended for RC with urinary diversion. We found that the surgical time was significantly shorter in the non-infection group. A prospective study based on our data is desirable to establish or revise PAA strategy for prophylactic medication to prevent postoperative infection after RC with urinary diversion.
本研究旨在探讨浸润性膀胱癌患者行根治性膀胱切除及尿流改道术后预防性使用抗生素(PAA)与术后感染之间的关联。
对49例连续病例进行前瞻性分析。术后感染分为手术部位感染(SSI)和远处感染(RI)。我们使用他唑巴坦/哌拉西林(TAZ/PIPC)作为预防性使用的抗生素(48小时)。
共有18例(36.7%)患者发生术后感染,其中4/18例(22.2%)患者发生伤口感染,12/18例(66.7%)患者发生远处感染。在对SSI和RI发生的危险因素研究中,我们发现非感染组的手术时间明显更短(p = 0.031)。综合这些结果表明,使用TAZ/PIPC且预防性使用抗生素时间较短(48小时)可能会导致较低的术后感染率。
我们的数据表明,对于行尿流改道根治性膀胱切除术的患者,可能推荐使用TAZ/PIPC且预防性使用抗生素时间较短(48小时)。我们发现非感染组的手术时间明显更短。基于我们的数据进行前瞻性研究,对于制定或修订预防性用药的PAA策略以预防尿流改道根治性膀胱切除术后的感染是很有必要的。