Kolwijck E, Seegers A E M, Tops S C M, van der Heijden A G, Sedelaar J P M, Ten Oever J
Radboud center for infectious diseases, Radboud university medical center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands.
Department of medical microbiology, Radboud university medical center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands.
BMC Infect Dis. 2019 Apr 3;19(1):303. doi: 10.1186/s12879-019-3932-4.
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.
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.
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.
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.
根治性膀胱切除术联合尿流改道术（UDS）后，术后感染很常见。减少术后感染需要针对致病菌进行适当的围手术期抗菌预防。我们评估了UDS术后30天内感染的发生率和微生物学情况，并调查了当前使用的围手术期抗菌预防措施的有效性。
对2014年1月至2016年9月在一所三级大学医学中心接受UDS的所有患者进行回顾性队列研究。根据荷兰国家指南，抗生素预防用药为头孢唑林加甲硝唑。主要结局是术后30天内的术后感染发生率。还评估了术后感染的危险因素和培养细菌的抗菌药敏谱。
纳入147例患者。69例患者（46.9%）发生了82次术后感染，其中27例为菌血症患者（18.4%）。感染发生率最高的时间是术后第4 - 5天和第8 - 10天。第二个高峰与输尿管支架取出有关。147例研究患者中有4.8%在支架取出后24小时发生菌血症，占本研究中发现的所有菌血症发作的25.9%。67.9%的血培养中培养出肠杆菌科细菌，这些细菌仅对环丙沙星、哌拉西林 - 他唑巴坦（90%）、美罗培南和庆大霉素（100%）高度敏感。多因素逻辑回归分析显示原位豪特曼新膀胱与感染并发症增加相关：比值比为4.1（95%置信区间1.6 - 10.5），p = 0.03。
根治性膀胱切除术后感染发生率很高，特别是输尿管支架取出与菌血症和复杂性尿路感染均相关。基于本研究结果，对于接受根治性膀胱切除术的患者，可能需要扩大抗生素预防的范围。需要进一步研究以调查在输尿管支架取出前给予抗生素预防的现行指南是否需要改变。
