Gayarre Abril P, Subirá Ríos J, Muñiz Suárez L, Murillo Pérez C, Ramírez Fabián M, Hijazo Conejos J I, Medrano Llorente P, García-Magariño Alonso J, Elizalde Benito F X, Aleson Hornos G, Pérez Abad L, Rioja Zuazu J, García Artal C, Blasco Beltrán B, Carrera Lasfuentes P, Marín Zaldivar C
Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
Actas Urol Esp (Engl Ed). 2021 May;45(4):247-256. doi: 10.1016/j.acuro.2020.10.001. Epub 2021 Jan 28.
Radical cystectomy with urinary diversion associated with extended pelvic lymphadenectomy continues to be the treatment of choice in muscle invasive bladder cancer. Sixty-four percent of patients submitted to this procedure present postoperative complications, with urinary infection being responsible in 20-40% of cases. The aim of this project is to assess the rate of urinary infection as a cause of re-admission after cystectomy, and to identify protective and predisposing factors for urinary infection in our environment. Finally, we will evaluate the outcomes after the establishment of a prophylactic antibiotic protocol after removal of ureteral catheters.
Retrospective descriptive study of cystectomized patients in the Urology Service of the Hospital Clínico Universitario of Zaragoza, from January 2012 to December 2018. A urinary tract infection (UTI) prevention protocol after catheter removal is established for all patients since October 2017.
UTI is responsible for 54.7% of readmissions, with 55.1% of these being due to UTI after removal of ureteral catheters. Of the patients who received with prophylaxis, 9.5% presented UTIs after withdrawal, compared to 10.6% in the group of patients without prophylaxis. The patient who is re-admitted for UTI after withdrawal has a mean catheter time of 24.3±7.2 days, compared to 24.5±7.4 days for patients in the group without UTI (P=.847).
The type of urinary diversion performed is not related to the rate of urinary infection. The regression model does not identify antibiotic prophylaxis, nor catheter time, as independent factors of UTI after catheter removal.
根治性膀胱切除术联合尿流改道术及扩大盆腔淋巴结清扫术仍是肌层浸润性膀胱癌的首选治疗方法。接受该手术的患者中有64%出现术后并发症，其中20 - 40%的病例由尿路感染引起。本项目的目的是评估尿路感染作为膀胱切除术后再次入院原因的发生率，并确定我们环境中尿路感染的保护因素和易感因素。最后，我们将评估拔除输尿管导管后建立预防性抗生素方案后的效果。
对2012年1月至2018年12月在萨拉戈萨大学临床医院泌尿外科接受膀胱切除术的患者进行回顾性描述性研究。自2017年10月起为所有患者制定了拔除导管后的尿路感染（UTI）预防方案。
UTI占再次入院原因的54.7%，其中55.1%是由于拔除输尿管导管后的UTI。在接受预防治疗的患者中，9.5%在拔除导管后出现UTI，而未接受预防治疗的患者组中这一比例为10.6%。因拔除导管后UTI再次入院的患者平均导管留置时间为24.3±7.2天，而无UTI组患者的平均导管留置时间为24.5±7.4天（P = 0.847）。
所进行的尿流改道类型与尿路感染率无关。回归模型未将抗生素预防或导管留置时间确定为拔除导管后UTI的独立因素。
