Kirkpatrick Carson, Haynes Allan, Sharma Pranav
Department of Urology, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA.
Bladder (San Franc). 2018 Aug 23;5(3):e35. doi: 10.14440/bladder.2018.722. eCollection 2018.
Majority of complications after ileal conduit urinary diversion with cystectomy are related to urinary tract infections (UTIs). Controversy exists regarding use of prophylactic antibiotics after surgery. We determined if prophylactic antibiotic use during ureteral stent placement after ileal conduit urinary diversion decreased incidence of UTI-related complications.
We retrospectively identified 75 consecutive patients who underwent ileal conduit urinary diversion with cystectomy at our institution from 2010 to 2016. Patients were stratified based on presence or absence of a UTI-related complication in the 90-day postoperative period. Means were compared with independent -test and proportions with chi-square analysis. Multivariate logistic regression was performed to determine independent predictors of UTI-related complications.
Forty-five patients (60%) were prescribed prophylactic antibiotics after surgery. Mean duration of antibiotic use was 15 d, and mean duration of ureteral stenting was 25 d. Most common antibiotics used included fluoroquinolones ( = 23, 30.7%) followed by sulfamethoxazole-trimethoprim ( = 14, 18.7%). Rate of 90-day UTI-related complications was 36% ( = 27), and 90-day UTI-related readmission rate was 14.7% ( = 11). On bivariate and multivariate analysis, prophylactic antibiotic use was not associated with reduced 90-day UTI-related complications ( > 0.05). Patients prescribed prophylactic antibiotics had increased incidence of infections in the 90-day postoperative period compared to controls (20% . 3.3%; = 0.038).
Prophylactic antibiotic use after ileal conduit urinary diversion with cystectomy was not associated with reduced UTI-related complications, and rate of infections was higher in this patient cohort. The effect of early removal of ureteral stents on UTI risk still has to be elucidated.
膀胱切除术后回肠代膀胱尿流改道术的大多数并发症与尿路感染（UTI）相关。术后预防性使用抗生素存在争议。我们确定了回肠代膀胱尿流改道术输尿管支架置入期间预防性使用抗生素是否能降低UTI相关并发症的发生率。
我们回顾性纳入了2010年至2016年在我院连续接受膀胱切除术后回肠代膀胱尿流改道术的75例患者。根据术后90天内是否发生UTI相关并发症对患者进行分层。采用独立样本t检验比较均值，采用卡方分析比较比例。进行多因素逻辑回归分析以确定UTI相关并发症的独立预测因素。
45例患者（60%）术后使用了预防性抗生素。抗生素平均使用时间为15天，输尿管支架置入平均时间为25天。最常用的抗生素包括氟喹诺酮类（n = 23，30.7%），其次是复方磺胺甲恶唑（n = 14，18.7%）。90天UTI相关并发症发生率为36%（n = 27），90天UTI相关再入院率为14.7%（n = 11）。在单因素和多因素分析中，预防性使用抗生素与90天UTI相关并发症的减少无关（P>0.05）。与对照组相比，接受预防性抗生素治疗的患者术后90天内感染发生率更高（20%对3.3%；P = 0.038）。
膀胱切除术后回肠代膀胱尿流改道术预防性使用抗生素与UTI相关并发症的减少无关，且该患者队列中的感染率更高。早期拔除输尿管支架对UTI风险的影响仍有待阐明。
