Vol.65 No.6 November 2017
Clinical study on the preventative efficacy of culture-based targeted antibiotic prophylaxis for febrile urinary tract infections after removal of ureteral stents in radical cystectomy patients with urinary diversion
1)Department of Urology, Okayama Rosai Hosipital, 1-10-25 Chikkou-Midorimachi, Minami-ku, Okayama, Japan
2)Clinical Laboratory, Okayama Rosai Hosipital
Abstract
Introduction and Objective
Radical cystectomy with intestinal urinary diversion is associated with a high incidence of postoperative infection (POI). We investigated the incidence of POI and evaluated the efficacy of targeted antibiotic prophylaxis (TAP) for prevention of febrile urinary tract infection (f-UTI) after removal of the ureteral stents.
Methods
From October 2008 to April 2017, a total of 50 patients who underwent radical cystectomy with intestinal urinary diversion were included in this study. Sulbactam/ampicillin, cefazolin or cefmetazole were intravenously administered before the operation and continued twice a day until postoperative day 2. Surgical site infection (SSI), remote infection (RI) and f-UTI were surveyed until postoperative day 30.
From July 2009, TAP was started. On post-operative day 7, prior to removal of ureteral stents, urine obtained from ureteral stents was cultured and determined the susceptibility of isolated bacteria. Forty-three patients received antibiotics for which the isolates were susceptible before the stent removal.
Results
Overall the incidence of POI was 40% (20/50). SSI, RI and f-UTI were observed in 7, 1 and 12 patients, respectively. Among f-UTI patients, 8 patients suffered from f-UTI following the removal of the ureteral stent. Although 5 out of 7 patients without TAP suffered from f-UTI, only 3 out of 43 patients with TAP encountered f-UTI. TAP significantly reduced the incidence of f-UTI after the stent removal (71% in patients without TAP vs 7.0% in patients with TAP; p=0.0008, Fisher's exact test).
Conclusion
The incidence of POI, especially f-UTI was high in radical cystectomy patients with intestinal urinary diversion. TAP can reduce the incidence of febrile UTI after the removal of ureteral stents.
Key word
radical cystectomy, post-operative infection, antimicrobial prophylaxis, urinary tract infection
Received
June 29, 2017
Accepted
September 21, 2017
Jpn. J. Chemother. 65 (6): 806-811, 2017
