Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
Urology. 2024 Jan;183:134-140. doi: 10.1016/j.urology.2023.09.007. Epub 2023 Sep 22.
To report microbial pathogens detected at infection-related readmissions, including their susceptibility to antimicrobials.
A retrospective review of 785 patients who underwent radical cystectomy for bladder cancer at a tertiary center in Denmark between 2009 and 2019. All patients received prophylactic cefuroxime preoperatively and pivmecillinam at stent- or catheter removal. Data were collected through the national medical records and microbiology database. The primary outcome was readmission rate and pathogens detected at infection-related readmissions. Univariable and multivariable regression analyses were carried out to identify risk factors of readmission.
Within 90days of surgery, 225 (29%) patients experienced at least one infection-related readmission. The most common pathogen identified was Enterococcus spp (24% of all positive samples). In blood cultures, the most dominant species were Escherichia coli (29%) and Staphylococcus spp (26%). Due to the heterogeneity in microbial species identified, more than one-third of the bacteria where mecillinam was tested showed resistance. Most isolates were susceptible to piperacillin+tazobactam. Orthotopic neobladder and continent cutaneous reservoir were associated with the highest risk of infection-related readmission compared to ileal conduit (odds ratios 2.78 [95%CI 1.66;4.65] and 3.08 [95%CI 1.58;5.98], respectively). Patients with diabetes had an increased risk of infection-related readmission compared to patients without diabetes (odds ratio 1.67 [95%CI 1.02;2.73]).
Nearly one-third of all patients experienced at least one postoperative infection-related readmission with a wide range of microbial etiologies. Generalizability of our results is uncertain, but the data can be used to plan interventional trials of antibiotic prophylaxis.
报告与感染相关再入院患者中检出的微生物病原体及其对抗菌药物的敏感性。
回顾性分析了 2009 年至 2019 年期间在丹麦一家三级中心接受根治性膀胱切除术的 785 例膀胱癌患者。所有患者术前均预防性使用头孢呋辛，支架或导管拔除时使用匹美西林。数据通过国家病历和微生物数据库收集。主要结局是再入院率和与感染相关再入院时检出的病原体。进行单变量和多变量回归分析以确定再入院的危险因素。
术后 90 天内，225 例（29%）患者至少发生了一次与感染相关的再入院。最常见的病原体是肠球菌属（所有阳性样本的 24%）。血培养中最主要的菌种是大肠埃希菌（29%）和葡萄球菌属（26%）。由于鉴定出的微生物种类存在异质性，超过三分之一的接受美西林测试的细菌表现出耐药性。大多数分离株对哌拉西林+他唑巴坦敏感。与回肠造口术相比，原位新膀胱和 continent 皮储尿囊与感染相关再入院的风险最高（比值比分别为 2.78[95%CI 1.66;4.65]和 3.08[95%CI 1.58;5.98]）。与无糖尿病患者相比，糖尿病患者感染相关再入院的风险增加（比值比 1.67[95%CI 1.02;2.73]）。
近三分之一的患者至少经历了一次与术后感染相关的再入院，其微生物病因广泛。我们的研究结果的普遍性不确定，但这些数据可用于计划抗生素预防的干预性试验。
