Werntz RP, et al. - The proposition explored herein was that continuous antibiotic prophylaxis decreased the urinary tract infections (UTIs) in the first 30 days following radical cystectomy in patients with urothelial carcinoma of the bladder. The yielded data shed light on the connection between prophylactic antibiotics in the 30 days following radical cystectomy with a substantial decrease in urinary tract infections and readmission from urosepsis after surgery.

Methods

• The enrollment consisted of patients with urothelial carcinoma of the bladder who underwent a radical cystectomy with urinary diversion for bladder cancer at Oregon Health and Science University from January 2014 to May 2015.
• In both groups, the ureteral stents were kept for 3 weeks.
• A Department Quality Initiative was enacted by the researchers in October 2014 to reduce UTIs.
• This was followed by discharge of all radical cystectomy patients, with antibiotic prophylaxis after a postoperative urine culture obtained during hospitalization.
• The effectiveness of the initiative was estimated by comparing the last 42 patients before the initiative to the first 42 patients after the initiative, in terms of the rate of UTI in the first 30 days following surgery.
• Comprehensive chart review plus the American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) assisted in identifyng UTI and readmission for urosepsis in the first 30 days following surgery, which would ensure an accurate capture of all patients developing a UTI.

Results

• Documented UTI was reported in 12% patients belonging to the prophylactic antibiotic group.
• In contrast, 36% in the no antibiotic group presented with a urinary tract infection (P < 0.004).
• One (2%) patient in the antibiotic group was readmitted for urosepsis when compared to 7 (17%) patients in the no antibiotic group admitted for urosepsis (P=0.02).
• Data did not disclose any correlation between urine culture at discharge and the development of UTI in the 30-day postdischarge period (P=0.75).
• The median time to UTI was discovered to be 19 days, with Enterococcus (32%) being the most commonly detected organism.
• The occurrence of UTI was noted in 30% patients not receiving prophylaxis, 1 day after ureteral stent removal.
• In the prophylaxis group, no patients developed UTI after stent removal.
• Adverse antibiotic related events were not reported.