Abstract
In radical cystectomy (RC), surgical-site infection (SSI) remains one of the most frustrating postoperative complications. Only a few reports have assessed SSI after RC according to the guideline authorized by the Centers for Disease Control and Prevention (CDC guideline). In this study, using the guideline, we assessed the incidence, causative organisms, classification, and risk factors for SSI in patients receiving RC with urinary diversion (UD). The subjects of this study were 104 patients who underwent RC with UD at the Department of Urology, Sapporo Medical University Hospital, between January 1996 and December 2003. As prophylactic antimicrobial agents, intravenous cephalosporins or penicillins were started before surgery and maintained until postoperative day 3. Patients who had preoperative bacteriuria were treated with antimicrobial agents before operation to eradicate the bacteria or reduce their number. The CDC guideline was used for the diagnosis of SSI. The overall incidence of SSI was 33%. The most frequent type of SSI was superficial incisional infection (71%). Methicillin-resistant Staphylococcus aureus (MRSA) was the most frequently isolated organism, accounting for 38% of the causative organisms. Operation time was shown to be a significant risk factor for SSI. Preoperative antibacterial chemotherapy for bacteriuria was not sufficiently efficacious to decrease the incidence of SSI. In our study, the incidence of SSI after RC was 33%, although 71% of the infections were superficial. It is necessary to establish more appropriate countermeasures to prevent SSI after RC with UD; in particular, that caused by MRSA.
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References
JB Thrasher ED Crawford (1993) ArticleTitleCurrent management of invasive and metastatic transitional cell carcinoma of the bladder J Urol 149 957–72 Occurrence Handle8483247
HA Frazier JE Robertson DF Paulson (1992) ArticleTitleComplications of radical cystectomy and urinary diversion: a retrospective review of 675 cases in two decades J Urol 148 1401–5 Occurrence Handle1433537
SS Chang MS Cookson RG Baumgartner N Wells JA Smith (2001) ArticleTitleAnalysis of early complications after radical cystectomy: results of a collaborative care pathway J Urol 167 2012–16
SS Chang RG Baumgartner N Wells MS Cookson JA Smith (2002) ArticleTitleCauses of increased hospital stay after radical cystectomy in a clinical pathway setting J Urol 167 208–11 Occurrence Handle10.1097/00005392-200201000-00047 Occurrence Handle11743307
A Yokoo T Hirose N Mikuma T Tsukamoto (1998) ArticleTitleIleal neobladder for bladder substitution after radical cystectomy Int J Urol 5 219–4 Occurrence Handle9624551
HL Kim GD Steinberg (2001) ArticleTitleComplications of cystectomy in patients with history of pelvic radiation Urology 58 557–60 Occurrence Handle10.1016/S0090-4295(01)01269-9 Occurrence Handle11597538
S Kanamaru A Terai S Ishitoya Y Kunishima H Nishiyama T Segawa et al. (2004) ArticleTitleAssessment of a protocol for prophylactic antibiotics to prevent perioperative infection in urological surgery: a preliminary study Int J Urol 11 355–63 Occurrence Handle10.1111/j.1442-2042.2004.00804.x Occurrence Handle15157202
AJ Mangram TC Horan ML Pearson LC Silver WR Jarvis (1999) ArticleTitleGuideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee Infect Control Hosp Epideminol 20 250–78
K Takeyama T Shimizu M Mutoh N Nishiyama Y Kunishima S Takahashi et al. (2004) ArticleTitleProphylactic antimicrobial agents in urological laparoscopic surgery: 1-day versus 3-day treatments J Infect Chemother 10 168–71 Occurrence Handle10.1007/s10156-004-0317-3 Occurrence Handle15290456
M Matsukawa Y Kunishima S Takahashi K Takeyama T Tsukamoto (2001) ArticleTitleStaphylococcus aureus bacteriuria and surgical site infections by methicillin-resistant Staphylococcus aureus Int J Antimicrob Agents 17 327–30 Occurrence Handle10.1016/S0924-8579(00)00358-7 Occurrence Handle11295417
Jiminez VK, Marshall FF. Surgery of bladder cancer. In: Walsh PC, Retik A, Vaughan ED, Wein AJ, editors. Campbell’s urology. 8th ed. 2002; p. 2819–44.
Mcdougal WS. Use of intestinal segments and urinary diversion. In: Walsh PC, Retik A, Vaughan ED, Wein AJ, editors. Campbell’s urology. 8th ed. 2002; p. 3745–88.
A Yokoo T Hirose N Mikuma T Tsukamoto (1998) ArticleTitleIleal neobladder for bladder substitution after radical cystectomy Int J Urol 5 219–24 Occurrence Handle9624551
UE Studer D Ackermann GA Casanova EJ Zingg (1989) ArticleTitleThree years’ experience with an ileal low pressure bladder substitute Br J Urol 63 43–52 Occurrence Handle2920259
A Le Duc M Camey P Teillac (1987) ArticleTitleAn original antireflux ureteroileal implantation technique; long-term follow-up J Urol 137 1156–8 Occurrence Handle3586146
R Hamasuna H Betsunoh T Sueyoshi K Yakushiji H Tsukino M Nagao et al. (2004) ArticleTitleBacteria of preoperative urinary tract infections contaminate the surgical fields and develop surgical site infections in urological operations Int J Urol 11 941–7 Occurrence Handle10.1111/j.1442-2042.2004.00941.x Occurrence Handle15509195
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Takeyama, K., Matsukawa, M., Kunishima, Y. et al. Incidence of and risk factors for surgical site infection in patients with radical cystectomy with urinary diversion. J Infect Chemother 11, 177–181 (2005). https://doi.org/10.1007/s10156-005-0391-1
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DOI: https://doi.org/10.1007/s10156-005-0391-1