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Predictors of surgical site infection after radical cystectomy: should we enhance surgical antibiotic prophylaxis?

  • Hanan Goldberg
  • Chen Shenhar
  • Hadar Tamir
  • Roy Mano
  • Jack Baniel
  • David Margel
  • Daniel Kedar
  • David Lifshitz
  • Ofer Yossepowitch
Original Article

Abstract

Purpose

To compare surgical site infections (SSI) rate after radical cystectomy (RC) over time and ascertain whether antibiotic prophylaxis should be enhanced.

Methods

All medical records of RC patients in a single tertiary uro-oncology center between 2007 and 2017 were analyzed. SSI was defined using the criteria of the US Centers for Disease Control and Prevention. All bacterial culture results and antimicrobial resistance rates were recorded. Lastly, multivariable logistic regression analysis was performed to ascertain SSI predictors.

Results

RC was performed in 405 patients, of which 96 (23.7%) developed SSI. No differences were demonstrated in the mean age, gender, NIDDM prevalence, neoadjuvant chemotherapy, positive preoperative urine culture, bowel preparation, and surgery time between both groups. However, statistically significant higher median BMI, age-adjusted Charlson Comorbidity score, usage of ceftriaxone preoperatively, and intensive care unit (ICU) hospitalization were noted in SSI patients. Overall, 62/96 (63.5%) SSI patients had a positive wound culture, with only 16.7% of the pathogens being sensitive to their perioperative antibiotics. Lastly, on multivariable analysis rising BMI, preoperative ceftriaxone and ICU hospitalization were associated with a higher SSI rate.

Conclusions

Preoperative BMI reduction, and maximal preoperative medical optimization in an attempt to lower ICU admittance rates, should be part of the ideal strategy for lowering SSI rates. Additionally, preoperative antibiotics should be enhanced to harbor-wide spectrum coverage, based on local resistance rates.

Keywords

Radical cystectomy Surgical site infection Surgical antibiotic prophylaxis 

Abbreviations

AUA

American Urology association

BMI

Body mass index

CDC

US Centers for Disease Control and Prevention

EAU

European association of Urology

ERAS

Enhanced recovery after surgery

IC

Ileal conduit

ICU

Intensive care unit

NC

Neoadjuvant chemotherapy

OR

Odds Ratio

RC

Radical cystectomy

RR

Relative risk

SAP

Surgical antibiotic prophylaxis

SSI

Surgical site infection

Notes

Author contributions

HG: project development, data collection, data analysis, manuscript writing. CS: project development, data collection, data analysis, manuscript writing. HT: data collection, data analysis. RM: data collection, data analysis, manuscript editing. JB: project development, manuscript editing. DM: project development, manuscript editing. DK: project development, manuscript editing. OY: project development, data analysis, manuscript writing and editing

Funding

No disclosures. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

As this was a retrospective study, this study did not contain any contact with human participants or animals performed by any of the authors.

Informed consent

As this was a retrospective study, no informed consent was required for this study by the internal review board.

Supplementary material

345_2018_2482_MOESM1_ESM.docx (17 kb)
Supplementary material 1 (DOCX 16 kb)
345_2018_2482_MOESM2_ESM.docx (15 kb)
Supplementary material 2 (DOCX 14 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of UrologyBeilinson Hospital, Rabin Medical Center and Tel Aviv University Sackler School of MedicinePetah TikvaIsrael

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