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Microbiological evaluation of infected pelvic lymphocele after robotic prostatectomy: potential predictors for culture positivity and selection of the best empirical antimicrobial therapy

  • Urology – Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Objectives

To examine symptomatology and microbiology of infected lymphocele (LC) post-robotic-assisted radical prostatectomy and pelvic lymph node dissection (PLND) and to assess for potential predictors for LC fluid culture positivity. Secondly, to provide general recommendations about use of select antimicrobial therapy.

Methods

This was a single-center, IRB-approved, retrospective, case series review conducted between October 2008 and October 2014. Data included symptomatology, microbiology of symptomatic LC in men post-robotic prostatectomy and PLND. Those with infected LC were compared to those men with symptomatic LC in the absence of infection.

Results

Symptomatic LC was seen in 7% of men, and among those, infected LC was seen in 42%. Infected LC cultures showed predominance of G+ cocci such as S. aureus, coagulase-negative Staphylococcus species, S. pyogenes, S. fecalis and S. viridans. Monomicrobial infection was seen in 85%. Multivariate logistic regression showed leukocytosis [Odds: 12.3, p = 0.03, 95% CI (1.2–125)] was significant predictor for culture positivity, whereas trend toward significance for factors such CT findings of thickened walls around the LC +/− air.

Conclusions

LC infection following PLND for prostate cancer is usually monomicrobial and caused by Gram+ cocci. GI tract and skin flora are the main habitat. High index of suspicion of infected LC is undertaken in the presence of leukocytosis, fever and abnormal CT findings. Based upon our local hospital antibiogram, combination of IV ampicillin/sulbactam and vancomycin is suggested as the best initial empiric therapy in treating these patients.

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Authors and Affiliations

  1. Division of Urology, Department of Surgery, St. Elizabeth’s Medical Center, Steward Health System, TUFTS University School of Medicine, 11 Nevins Street, MOB, Suite 303, Boston, MA, 02135, USA

    Alaa Hamada & Ingolf Tuerk

  2. TUFTS University/Medical School, Boston, MA, USA

    Catalina Hwang

  3. Division of Infectious Disease, Department of Medicine, St. Elizabeth’s Medical Center, Steward Health System, TUFTS University School of Medicine, Boston, MA, 02135, USA

    Jorge Fleisher

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  1. Alaa Hamada
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  2. Catalina Hwang
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  4. Ingolf Tuerk
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Correspondence to Alaa Hamada.

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All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study involving were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

This was IRB-approved retrospective analysis of clinical records. No informed consent for the participants was needed.

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Hamada, A., Hwang, C., Fleisher, J. et al. Microbiological evaluation of infected pelvic lymphocele after robotic prostatectomy: potential predictors for culture positivity and selection of the best empirical antimicrobial therapy. Int Urol Nephrol 49, 1183–1191 (2017). https://doi.org/10.1007/s11255-017-1599-6

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  • DOI: https://doi.org/10.1007/s11255-017-1599-6

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