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Lokeshwar SD, Choksi AU, Smani S, Ip KL, Javier-DesLoges JF, Rahman SN, Leapman MS, Martin TV, Hesse DG. Classification and Risk Factors for Surgical Site Infections in Radical Cystectomy: A 16-Year Analysis. Surg Infect (Larchmt) 2024. [PMID: 38959160 DOI: 10.1089/sur.2024.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024] Open
Abstract
Introduction: Surgical site infection (SSI) is a substantial cause of peri-operative morbidity among patients undergoing radical cystectomy (RC). The purpose of this study was to identify the risk factors of SSI after RC and to classify and characterize treatment of SSIs. Methods: We retrospectively analyzed peri-operative characteristics and SSI, for patients undergoing RC from 2007 to 2022. Patients were stratified by SSI versus no SSI and differences were assessed. Uni-variable/multi-variable logistic regression analyses were performed to identify factors associated with SSI. SSIs were categorized by the Centers for Disease Control and Prevention (CDC) type: Superficial incisional, deep incisional, and organ/space confined. Results: Three hundred and ninety-eight patients had RC, 279 open, and 119 robotic; 78 (19.6%) developed SSI. Cohorts were similar demographically. Length of stay (LOS) was longer in the SSI cohort (8.8 d versus 12.4 d, p < 0.001), and body mass index (BMI) was greater in patients with SSI (24.34 vs. 25.39, p = 0.0003). On uni-variable analysis, age, gender, Charlson Comorbidity Index, diabetes mellitus, diversion, odds ratio (OR) time, blood loss, and open versus robotic technique were not substantial SSI predictors. BMI was an independent risk factor for SSI on both uni-variable (OR: 1.07, 95% confidence interval [CI]: 1.018-1.115, p = 0.0061) and multi-variable analysis (OR: 1.06, 95% CI: 1.009-1.109, p = 0.02) for 10 (12.8%) and 24 (30.8%) superficial and deep-incisional SSIs, respectively. Superficial wound SSI was treated conservatively with 60% receiving antibiotic agents and no procedural intervention. Deep SSIs received antibiotic agents and 50% required surgical intervention. There were 44 (56.4%) organ/space SSIs, and the most common treatment was antibiotic agents (100%) and IR drain placement (30, 68.2%). Conclusion: In patients undergoing RC, BMI was an independent risk factor for SSI. Type of the surgical procedure, robotic versus open, was not predictive of SSI. LOS was longer for patients with SSI. SSI was managed differently depending on CDC classification.
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Affiliation(s)
- Soum D Lokeshwar
- Department of Urology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ankur U Choksi
- Department of Urology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Shayan Smani
- Department of Urology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kevan L Ip
- Department of Urology, Jefferson School of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Syed N Rahman
- Department of Urology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael S Leapman
- Department of Urology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Thomas V Martin
- Department of Urology, Yale School of Medicine, New Haven, Connecticut, USA
| | - David G Hesse
- Department of Urology, Yale School of Medicine, New Haven, Connecticut, USA
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Blachman-Braun R, Gurayah AA, Mason MM, Hougen HY, Gonzalgo ML, Nahar B, Punnen S, Parekh DJ, Ritch CR. Incidence and predictors of deep incisional and organ/space surgical site infection following radical cystectomy. Urol Oncol 2023; 41:455.e17-455.e24. [PMID: 37524577 DOI: 10.1016/j.urolonc.2023.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/01/2023] [Accepted: 06/26/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE To investigate clinical risk factors associated with postoperative deep incisional or organ/space surgical site infections (SSI) following radical cystectomy (RC) in a well characterized and large contemporary cohort. METHODS We used the American College of Surgeons National Surgical Quality Improvement Program database to identify adult patients who underwent RC for bladder cancer between 2015 and 2020 (n = 13,081). We conducted multivariable-adjusted logistic regression and Cox adjusted proportional hazards regression analysis to identify clinical predictors of deep incisional or organ/space SSI in the 30-day postoperative-period following RC. RESULTS Deep incisional or organ/space SSI risk increased with continent urinary diversion (HR = 1.61, 95% CI: 1.38-1.88; P < 0.001), obesity (HR = 1.60, 95% CI: 1.35-1.90; P < 0.001), diabetes mellitus (HR = 1.30, 95% CI: 1.13-1.51; P < 0.001), and being functionally dependent before surgery (HR = 2.09, 95% CI: 1.44-3.03; P < 0.001). CONCLUSIONS Postoperative deep incisional or organ/space SSIs following RC occur more frequently in patients who were obese, diabetic, functionally dependent before surgery, and those who underwent continent urinary diversion. These findings may assist urologists in preoperative counseling, medical optimization, and choice of urinary diversion approach, as well as improved patient monitoring and identification of candidates for intervention postoperatively.
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Affiliation(s)
- Ruben Blachman-Braun
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL.
| | | | | | - Helen Y Hougen
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Mark L Gonzalgo
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, Miami, FL
| | - Bruno Nahar
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, Miami, FL
| | - Sanoj Punnen
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, Miami, FL
| | - Dipen J Parekh
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, Miami, FL
| | - Chad R Ritch
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, Miami, FL
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3
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Antonelli L, Sebro K, Lahmar A, Black PC, Ghodoussipour S, Hamilton-Reeves JM, Shah J, Bente Thoft J, Lerner SP, Llorente C, Lucca I, Preston MA, Psutka SP, Sfakianos JP, Vahr Lauridsen S, Williams SB, Catto J, Djaladat H, Kassouf W, Loftus K, Daneshmand S, Fankhauser CD. Association Between Antibiotic Prophylaxis Before Cystectomy or Stent Removal and Infection Complications: A Systematic Review. Eur Urol Focus 2023:S2405-4569(23)00028-7. [PMID: 36710211 DOI: 10.1016/j.euf.2023.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/24/2022] [Accepted: 01/17/2023] [Indexed: 01/29/2023]
Abstract
CONTEXT Patients undergoing radical cystectomy frequently suffer from infectious complications, including urinary tract infections (UTIs) and surgical site infections (SSIs) leading to emergency department visits, hospital readmission, and added cost. OBJECTIVE To summarize the literature regarding perioperative antibiotic prophylaxis, ureteric stent usage, and prevalence of infectious complications after cystectomy. EVIDENCE ACQUISITION A systematic review of PubMed/Medline, EMBASE, Cochrane Library, and reference lists was conducted. EVIDENCE SYNTHESIS We identified 20 reports including a total of 55 306 patients. The median rates of any infection, UTIs, SSIs, and bacteremia were 40%, 20%, 11%, and 6%, respectively. Perioperative antibiotic prophylaxis differed substantially between reports. Perioperative antibiotics were used only during surgery in one study but were continued over several days after surgery in all other studies. Empirical use of antibiotics for 1-3 d after surgery was described in 12 studies, 3-10 d in two studies, and >10 d in four studies. Time to stent removal ranged from 4 to 25 d after cystectomy. Prophylactic antibiotics were used before stent removal in nine of 20 studies; two of these studies used targeted antibiotics based on urine cultures from the ureteric stents, and the other seven studies used a single shot or 2 d of empirical antibiotics. Studies with any prophylactic antibiotic before stent removal found a lower median percentage of positive blood cultures after stent removal than studies without prophylactic antibiotics before stent removal (2% vs 9%). CONCLUSIONS We confirmed a high proportion of infectious complications after cystectomy, and a heterogeneous pattern of choice and duration of antibiotics during and after surgery or stent removal. These findings highlight a need for further studies and support quality prospective trials. PATIENT SUMMARY In this review, we observed wide variability in the use of antibiotics before or after surgical removal of the bladder.
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Affiliation(s)
- Luca Antonelli
- Department of Urology, Luzerner Kantonsspital, University of Lucerne, Lucerne, Switzerland; Department of Urology, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Kirby Sebro
- Department of Urology, Western General Hospital, Edinburgh, UK
| | - Abdelilah Lahmar
- Medicine, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Oujda, Morocco
| | - Peter C Black
- Vancouver Prostate Centre and Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Saum Ghodoussipour
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | | | - Jay Shah
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Seth Paul Lerner
- Scott Department of Urology, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Carlos Llorente
- Department of Urology and Research Unit, Hospital Universitario Fundación Alcorcon, Alcorcón, Madrid, Spain
| | - Ilaria Lucca
- Department of Urology, CHUV, Lausanne, Switzerland
| | - Mark A Preston
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sarah P Psutka
- Department of Urology, University of Washington, Seattle, WA, USA
| | - John P Sfakianos
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Susanne Vahr Lauridsen
- Department of Urology, Copenhagen University Hospital, Copenhagen, Denmark; WHO-CC, Parker Institute Bispebjerg & Frederiksberg University Hospital, Copenhagen, Denmark
| | - Stephen B Williams
- Division of Urology, Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - James Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Hooman Djaladat
- Institute of Urology, Kenneth Norris Jr. Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Wassim Kassouf
- Department of Surgery (Urology), Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Katherine Loftus
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn school of Medicine at Mount Sinai, New York, NY, USA
| | - Siamak Daneshmand
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Christian D Fankhauser
- Department of Urology, Luzerner Kantonsspital, University of Lucerne, Lucerne, Switzerland.
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Ross J, Breau RH, McAlpine K, Rowe N, Williams L, Knee C, Cagiannos I, Morash C, Mallick R, van Walraven C, Lavallée LT. A novel prevention bundle to reduce incisional infections after radical cystectomy. Urol Oncol 2020; 38:638.e1-638.e6. [PMID: 32409199 DOI: 10.1016/j.urolonc.2020.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/15/2020] [Accepted: 04/03/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Our institution implemented a novel intervention bundle to reduce incisional surgical site infections (SSIs) for patients undergoing radical cystectomy. The primary objective of this study was to evaluate the efficacy of the bundle in reducing incisional SSIs post-cystectomy. MATERIAL AND METHODS A before-after cohort study was performed on all patients who underwent radical cystectomy by urologic oncologists at The Ottawa Hospital from January 2016 to March 2019. Thirty-day postoperative incisional SSIs were identified from the medical record and were compared to institutionally collected National Surgical Quality Improvement Program data. The SSI reduction strategy was implemented as of March 1st, 2018. Adjusted associations between the SSI intervention with the risk of incisional SSI were determined. Cystectomy incisional SSI rates were compared to all other National Surgical Quality Improvement Program-collected surgeries at The Ottawa Hospital during the same time period. RESULTS One hundred and thirty-two patients were included; 41 following implementation of the SSI reduction bundle. Mean age was 69 years, 104 (79%) were male, and 59 (45%) received neobladders. The risk of incisional SSI decreased from 16.5% preintervention to 2.4% post intervention (risk ratio 0.17; P = 0.004). Intraoperative transfusion and diabetes were independently associated with an increased risk of incisional SSI (P < 0.05). The SSI rate for all other surgical procedures at our institution remained stable during the same time period. CONCLUSIONS The risk of SSI after radical cystectomy is high. Use of an SSI reduction bundle was associated with a large reduction in incisional SSIs. Further evaluation of this intervention in other centers is warranted.
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Affiliation(s)
- James Ross
- Department of Surgery, Division of Urology, University of Ottawa, Ottawa, ON, Canada
| | - Rodney H Breau
- Department of Surgery, Division of Urology, University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kristen McAlpine
- Department of Surgery, Division of Urology, University of Ottawa, Ottawa, ON, Canada
| | - Neal Rowe
- Department of Surgery, Division of Urology, University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Lara Williams
- Department of Surgery, Division of General Surgery, University of Ottawa, Ottawa, ON, Canada
| | | | - Ilias Cagiannos
- Department of Surgery, Division of Urology, University of Ottawa, Ottawa, ON, Canada
| | - Christopher Morash
- Department of Surgery, Division of Urology, University of Ottawa, Ottawa, ON, Canada
| | | | - Carl van Walraven
- Ottawa Hospital Research Institute, Ottawa, ON, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Institute for Clinical Evaluative Sciences, Ottawa, ON, Canada
| | - Luke T Lavallée
- Department of Surgery, Division of Urology, University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
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Risk of infection in patients undergoing urologic surgery based on the presence of asymptomatic bacteriuria: A prospective study. Am J Infect Control 2019; 47:1474-1478. [PMID: 31375294 DOI: 10.1016/j.ajic.2019.06.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/18/2019] [Accepted: 06/19/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Treatment of asymptomatic bacteriuria (ASB) is recommended in pregnant women and prior to urologic procedures with anticipated mucosal disruption. However, there is still insufficient evidence of the usefulness of treating ASB prior to urologic procedures. Therefore, the aim of this study was to ascertain the risk of infections in patients undergoing urologic surgery based on the presence of ASB. METHODS We conducted a cohort study among patients undergoing urologic surgery at a single center located in Medellín, Colombia. All patients were screened for ASB prior to their procedures. Patients were evaluated for the development of any postoperative infectious complications for up to 30 days after the procedure. RESULTS A total of 149 patients were included in this cohort. Incidence of ASB was 14.8%. Thirteen patients (8.72%) developed infectious complications: 3 (13.64%) with ASB and 10 (7.87%) without ABS. Factors associated with postoperative infectious complications included urologic cancers (hazard ratio [HR], 5.26; 95% confidence intervals [CI], 1.24-22.37), urologic interventions in the preceding 3 months (HR, 3.72; 95% CI, 1.02-13.51), and use of antibiotics 3 months prior to surgery (HR, 3.83; 95% CI, 1.01-15.49). Presence of ASB was not associated with postsurgical infectious complications (HR, 1.02; 95% CI, 0.26-3.96). CONCLUSIONS There was no association between ASB and postoperative infectious complications. There were other factors associated with infectious complications, such as urologic cancer, previous history of urologic manipulation, and antibiotic use.
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Kolwijck E, Seegers AEM, Tops SCM, van der Heijden AG, Sedelaar JPM, Ten Oever J. Incidence and microbiology of post-operative infections after radical cystectomy and ureteral stent removal; a retrospective cohort study. BMC Infect Dis 2019; 19:303. [PMID: 30943902 PMCID: PMC6448312 DOI: 10.1186/s12879-019-3932-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 03/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Post-operative infections are frequent after radical cystectomy with urinary diversion surgery (UDS). Reduction of post-operative infections necessitates appropriate peri-operative antimicrobial prophylaxis targeting causative bacteria. We assessed the incidence and microbiology of infections in the 30-day post-operative period after UDS and investigated effectiveness of the currently used peri-operative antibacterial prophylaxis. METHODS Retrospective cohort study of all patients undergoing UDS in a tertiary university medical center from January 2014 until September 2016. Antibiotic prophylaxis consisted of cefazolin plus metronidazol according to the Dutch national guideline. Primary outcome was the incidence of post-operative infections within 30 days. Risk factors for post-operative infections and antimicrobial susceptibility profiles of cultured bacteria were also assessed. RESULTS 147 patients were included. 69 patients (46.9%) had 82 post-operative infections, 27 of which were patients with bacteremia (18.4%). Highest incidence of infections was on day 4-5 and on day 8-10 postoperatively. The second peak was associated with ureteral stent removal. 4.8% of 147 study patients developed bacteremia 24 h after stent removal, which counted for 25.9% of all bacteremia episodes found in this study. Enterobacteriaceae were cultured in 67.9% of blood cultures and were only highly susceptible to ciprofloxacine, piperacillin-tazobactam (90%), meropenem and gentamicin (100%). Multivariate logistic regression analysis showed orthotopic Hautmann neobladder to be associated with increased infections complications: odds ratio 4.1 (95% confidence interval 1.6-10.5), p = 0.03. CONCLUSIONS The incidence of infections after radical cystectomy is high and particularly ureteral stent removal was associated with both bacteremia and complicated urinary tract infections. Based on the results of this study, antibiotic prophylaxis might need to be broadened for patients undergoing radical cystectomy. Further research is required to investigate whether current guidelines need to be altered concerning administration of antibiotic prophylaxis just before stent removal.
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Affiliation(s)
- E Kolwijck
- Radboud center for infectious diseases, Radboud university medical center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands. .,Department of medical microbiology, Radboud university medical center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands.
| | - A E M Seegers
- Radboud center for infectious diseases, Radboud university medical center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands.,Department of medical microbiology, Radboud university medical center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands.,Department of internal medicine, Radboud university medical center, Nijmegen, the Netherlands
| | - S C M Tops
- Radboud center for infectious diseases, Radboud university medical center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands.,Department of medical microbiology, Radboud university medical center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands.,Department of internal medicine, Radboud university medical center, Nijmegen, the Netherlands
| | - A G van der Heijden
- Department of urology, Radboud university medical center, Nijmegen, the Netherlands
| | - J P M Sedelaar
- Department of urology, Radboud university medical center, Nijmegen, the Netherlands
| | - J Ten Oever
- Radboud center for infectious diseases, Radboud university medical center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands.,Department of internal medicine, Radboud university medical center, Nijmegen, the Netherlands
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7
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Kolwijck E, Seegers AEM, Tops SCM, van der Heijden AG, Sedelaar JPM, Ten Oever J. Incidence and microbiology of post-operative infections after radical cystectomy and ureteral stent removal; a retrospective cohort study. BMC Infect Dis 2019. [PMID: 30943902 DOI: 10.1186/s12879.019-3932-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Post-operative infections are frequent after radical cystectomy with urinary diversion surgery (UDS). Reduction of post-operative infections necessitates appropriate peri-operative antimicrobial prophylaxis targeting causative bacteria. We assessed the incidence and microbiology of infections in the 30-day post-operative period after UDS and investigated effectiveness of the currently used peri-operative antibacterial prophylaxis. METHODS Retrospective cohort study of all patients undergoing UDS in a tertiary university medical center from January 2014 until September 2016. Antibiotic prophylaxis consisted of cefazolin plus metronidazol according to the Dutch national guideline. Primary outcome was the incidence of post-operative infections within 30 days. Risk factors for post-operative infections and antimicrobial susceptibility profiles of cultured bacteria were also assessed. RESULTS 147 patients were included. 69 patients (46.9%) had 82 post-operative infections, 27 of which were patients with bacteremia (18.4%). Highest incidence of infections was on day 4-5 and on day 8-10 postoperatively. The second peak was associated with ureteral stent removal. 4.8% of 147 study patients developed bacteremia 24 h after stent removal, which counted for 25.9% of all bacteremia episodes found in this study. Enterobacteriaceae were cultured in 67.9% of blood cultures and were only highly susceptible to ciprofloxacine, piperacillin-tazobactam (90%), meropenem and gentamicin (100%). Multivariate logistic regression analysis showed orthotopic Hautmann neobladder to be associated with increased infections complications: odds ratio 4.1 (95% confidence interval 1.6-10.5), p = 0.03. CONCLUSIONS The incidence of infections after radical cystectomy is high and particularly ureteral stent removal was associated with both bacteremia and complicated urinary tract infections. Based on the results of this study, antibiotic prophylaxis might need to be broadened for patients undergoing radical cystectomy. Further research is required to investigate whether current guidelines need to be altered concerning administration of antibiotic prophylaxis just before stent removal.
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Affiliation(s)
- E Kolwijck
- Radboud center for infectious diseases, Radboud university medical center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands. .,Department of medical microbiology, Radboud university medical center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands.
| | - A E M Seegers
- Radboud center for infectious diseases, Radboud university medical center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands.,Department of medical microbiology, Radboud university medical center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands.,Department of internal medicine, Radboud university medical center, Nijmegen, the Netherlands
| | - S C M Tops
- Radboud center for infectious diseases, Radboud university medical center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands.,Department of medical microbiology, Radboud university medical center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands.,Department of internal medicine, Radboud university medical center, Nijmegen, the Netherlands
| | - A G van der Heijden
- Department of urology, Radboud university medical center, Nijmegen, the Netherlands
| | - J P M Sedelaar
- Department of urology, Radboud university medical center, Nijmegen, the Netherlands
| | - J Ten Oever
- Radboud center for infectious diseases, Radboud university medical center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands.,Department of internal medicine, Radboud university medical center, Nijmegen, the Netherlands
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Alonso-García M, de-la-Morena J, de-la-Peña E, Martínez-Hurtado J, Lucas W, del-Moral-Luque J, Villar-del-Campo M, Gil-de-Miguel A, Rodríguez-Caravaca G. Incidence of surgical wound infection in renal surgery. The effect of antibiotic prophylaxis appropriateness. A prospective cohort study. Actas Urol Esp 2018; 42:639-644. [PMID: 30518487 DOI: 10.1016/j.acuro.2018.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 04/17/2018] [Accepted: 04/18/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To assess compliance with the antibiotic prophylaxis protocol for patients who underwent renal surgery and its effect on the incidence of surgical wound infection. MATERIAL AND METHODS We performed a prospective cohort study and assessed the overall compliance and each aspect of the antibiotic prophylaxis (start, administration route, antibiotic of choice, duration and dosage) and reported the compliance rates. The qualitative variables were compared with the chi-squared test, and the quantitative variables were compared with Student's t-test. We studied the effect of antibiotic prophylaxis compliance on the incidence of surgical wound infection in renal surgery, with the relative risk. RESULTS The study included 266 patients, with an overall compliance rate of 90.6%. The major cause of noncompliance (3.8%) was the start of the prophylaxis, and the incidence rate of surgical wound infections was 3.4%. We found no relationship between antibiotic prophylaxis noncompliance and surgical wound infections (RR=0.26; 95%CI: 0.1-1.2; P>.05). Laparoscopic surgery had a lower incidence of surgical wound infections than open surgery (RR=0.10; 95%CI: 0.01-0.79). CONCLUSIONS The antibiotic prophylaxis compliance was high. The incidence of surgical site infection was low, and there was no relationship between the incidence of surgical site infection and antibiotic prophylaxis compliance. The incidence of infection was lower in laparoscopic surgery.
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Goldberg H, Shenhar C, Tamir H, Mano R, Baniel J, Margel D, Kedar D, Lifshitz D, Yossepowitch O. Predictors of surgical site infection after radical cystectomy: should we enhance surgical antibiotic prophylaxis? World J Urol 2018; 37:1137-1143. [PMID: 30220044 DOI: 10.1007/s00345-018-2482-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 09/08/2018] [Indexed: 12/28/2022] Open
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.
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Affiliation(s)
- Hanan Goldberg
- Department of Urology, Beilinson Hospital, Rabin Medical Center and Tel Aviv University Sackler School of Medicine, Petah Tikva, Israel.
| | - Chen Shenhar
- Department of Urology, Beilinson Hospital, Rabin Medical Center and Tel Aviv University Sackler School of Medicine, Petah Tikva, Israel
| | - Hadar Tamir
- Department of Urology, Beilinson Hospital, Rabin Medical Center and Tel Aviv University Sackler School of Medicine, Petah Tikva, Israel
| | - Roy Mano
- Department of Urology, Beilinson Hospital, Rabin Medical Center and Tel Aviv University Sackler School of Medicine, Petah Tikva, Israel
| | - Jack Baniel
- Department of Urology, Beilinson Hospital, Rabin Medical Center and Tel Aviv University Sackler School of Medicine, Petah Tikva, Israel
| | - David Margel
- Department of Urology, Beilinson Hospital, Rabin Medical Center and Tel Aviv University Sackler School of Medicine, Petah Tikva, Israel
| | - Daniel Kedar
- Department of Urology, Beilinson Hospital, Rabin Medical Center and Tel Aviv University Sackler School of Medicine, Petah Tikva, Israel
| | - David Lifshitz
- Department of Urology, Beilinson Hospital, Rabin Medical Center and Tel Aviv University Sackler School of Medicine, Petah Tikva, Israel
| | - Ofer Yossepowitch
- Department of Urology, Beilinson Hospital, Rabin Medical Center and Tel Aviv University Sackler School of Medicine, Petah Tikva, Israel
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Comparison of guideline recommendations for antimicrobial prophylaxis in urologic procedures: variability, lack of consensus, and contradictions. Int Urol Nephrol 2018; 50:1923-1937. [DOI: 10.1007/s11255-018-1971-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 08/18/2018] [Indexed: 10/28/2022]
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11
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Alonso-Isa M, Medina-Polo J, Lara-Isla A, Pérez-Cadavid S, Arrébola-Pajares A, Sopeña-Sutil R, Benítez-Sala R, Justo-Quintas J, Gil-Moradillo J, Passas-Martínez JB, Tejido-Sánchez A. Surgical wound infection in urology. Analysis of risk factors and associated microorganisms. Actas Urol Esp 2017; 41:109-116. [PMID: 27567274 DOI: 10.1016/j.acuro.2016.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 07/12/2016] [Accepted: 07/13/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Open surgery continues to have a fundamental role in urology, and one of its main complications is surgical wound infection. Our objective was to analyse surgical wound infection in patients who underwent surgery in our Department of Urology and to assess the risk factors, microorganisms and resistances by type of surgery. MATERIAL AND METHODS This was a prospective observational study that included 940 patients: 370 abdominal/open lumbar surgeries and 570 genitoperineal surgeries. We analysed age, sex, comorbidities, stay and type of surgery, as well as the causal microorganisms and antibiotic resistances. RESULTS For genitoperineal surgery, we found 15 cases (2.6%) of surgical wound infection associated with previous urinary catheterisation. Most of the isolated microorganisms corresponded to enterobacteriaceae, highlighting the resistance to beta-lactam. In abdominal/lumbar surgery, we found 41 cases (11.1%) of surgical wound infection. The incidence rate was 3.3% in prostate surgery; 9.8% in renal surgery; and 45.0% in cystectomy. Heart disease was associated with a higher incidence rate of surgical wound infection. The most common microorganisms were Enterococcus spp. (27.1%), E.coli (22.9%) and Staphylococcus aureus (14.6%). Enterococcus and beta-lactamase-producing E.coli are resistant to ampicillin in 37.5% and 41.7% of cases, respectively. CONCLUSIONS We found a low incidence rate of surgical wound infection in genitoperineal surgery, compared with renal surgery and cystectomy. The presence of heart disease and carrying a previous urinary catheter are factors associated with surgical wound infection. Enterococcus and E.coli are the most common pathogens, with high rates of resistance.
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Affiliation(s)
- M Alonso-Isa
- Servicio de Urología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - J Medina-Polo
- Servicio de Urología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España.
| | - A Lara-Isla
- Servicio de Urología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - S Pérez-Cadavid
- Servicio de Urología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - A Arrébola-Pajares
- Servicio de Urología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - R Sopeña-Sutil
- Servicio de Urología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - R Benítez-Sala
- Servicio de Urología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - J Justo-Quintas
- Servicio de Urología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - J Gil-Moradillo
- Servicio de Urología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - J B Passas-Martínez
- Servicio de Urología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - A Tejido-Sánchez
- Servicio de Urología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
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12
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[Antibiotic prophylaxis in urology]. Urologia 2014; 81:209-17. [PMID: 25532466 DOI: 10.5301/uro.5000098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2014] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Antibiotic prophylaxis (AP) is used to minimize infectious complications resulting from interventions. Due to high rates of development of bacterial resistance and side effects, the use of antibiotics must be weighed on the basis of high levels of evidence. The main endpoints of urology AP are the prevention of symptomatic urogenital infections, urosepsis and wound infections. The purpose of this review is to bring objectives, principles and recommendations on urology AP according to the latest scientific evidence. METHODS We carried out a systematic search of MEDLINE, EMBASE and the Cochrane Library using keywords such as AP, prophylaxis, antibiotics, urological surgery, urogenital surgery and the names of the urologic procedures. The results of studies on the AP for each procedure were classified according to the levels of evidence and grades of recommendation from the European Association of Urology. RESULTS There are a number of good quality studies on AP about endoscopic resection of the prostate (TURP), urodynamic studies and transrectal prostate biopsies (trPB). The majority of the studies about other procedures have several limitations (sample size, consistency of definitions, statistics and trial design). Lack of consistency in the definitions of infectious complications does not allow comparison between different studies. CONCLUSIONS The AP is evidence-based is indicated only for TURP and trPB. It is desirable to perform randomized, prospective and controlled trials in order to rationalize the use of antibiotics, improve the cost/benefit ratio and reduce bacterial antibiotic resistances.
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Yamamoto T, Takahashi S, Ichihara K, Hiyama Y, Uehara T, Hashimoto J, Hirobe M, Masumori N. How do we understand the disagreement in the frequency of surgical site infection between the CDC and Clavien-Dindo classifications? J Infect Chemother 2014; 21:130-3. [PMID: 25434696 DOI: 10.1016/j.jiac.2014.10.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 10/12/2014] [Accepted: 10/25/2014] [Indexed: 10/24/2022]
Abstract
To clarify the discrepancy in the incidence and severity of surgical site infections (SSI) for radical cystectomy between reports based on the CDC guideline and those using the Clavien-Dindo classification we evaluated 449 consecutive patients who underwent radical cystectomy for bladder cancer between 1990 and 2012. Of the 115 (25.6%) patients with SSI defined by the CDC guideline, 89 could be analyzed. We compared the SSI rates and severity defined by the CDC guideline and Clavien-Dindo classifications. There were 58 patients with superficial SSI, 16 with deep SSI, and 15 with organ/space SSI according to the CDC guideline. All patients with organ/space SSI were judged as "not having SSI" by the Clavien-Dindo classification. They were classified as having "intestinal prolapse", "intestinal fistula", "abdominal abscess" and "pelvic abscess." There was a significant association between the treatment duration and depth of SSI based on the CDC guideline by Spearman's rank-correlation coefficient (p < 0.001, r = 0.614) and with the grade of complications (p < 0.001, r = 0.632) in the Clavien-Dindo classification. Multivariate analysis showed that patients with grade III SSI in the Clavien-Dindo classification needed a significantly longer treatment duration. It is necessary to be aware that a discrepancy can occur automatically due to the different natures of the definitions. Using the CDC guideline, we can effectively estimate the future treatment period when SSI occurs. With the Clavien-Dindo classification, grade III SSI requires a longer treatment duration.
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Affiliation(s)
- Takanobu Yamamoto
- Department of Urology, Sapporo Medical University School of Medicine, Japan.
| | - Satoshi Takahashi
- Department of Urology, Sapporo Medical University School of Medicine, Japan.
| | - Koji Ichihara
- Department of Urology, Sapporo Medical University School of Medicine, Japan
| | - Yoshiki Hiyama
- Department of Urology, Sapporo Medical University School of Medicine, Japan
| | - Teruhisa Uehara
- Department of Urology, Sapporo Medical University School of Medicine, Japan
| | - Jiro Hashimoto
- Department of Urology, Sapporo Medical University School of Medicine, Japan
| | - Megumi Hirobe
- Department of Urology, Sapporo Medical University School of Medicine, Japan
| | - Naoya Masumori
- Department of Urology, Sapporo Medical University School of Medicine, Japan
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Novel closing method using subcutaneous continuous drain for preventing surgical site infections in radical cystectomy. ISRN UROLOGY 2014; 2014:897451. [PMID: 24734201 PMCID: PMC3964757 DOI: 10.1155/2014/897451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 02/09/2014] [Indexed: 11/17/2022]
Abstract
To reduce the incidence of surgical site infection (SSI) after radical cystectomy, a new closing method using subcutaneous continuous aspiration drain was developed and compared to the conventional closing method. The new method involved (a) closed aspiration with an indwelling aspiration drain without suture of the subcutaneous fat and (b) covering with hydrocolloid wound dressing after suture of the dermis with 4-0 absorbable thread and reinforcement using strips. The incidence of SSI was significantly improved by using the new method. Furthermore, univariate and multivariate analysis associated with SSI revealed that the new closing method was statistically correlated with 85% reduction of SSI (odds ratio: 0.15, 95% confidence interval: 0.03–0.69).Our new method using continuous aspiration with subcutaneous drain is useful for preventing SSI through removal of effusions and reduction of dead space by apposition of the subcutaneous fat.
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Uehara T, Takahashi S, Ichihara K, Hiyama Y, Hashimoto J, Kurimura Y, Masumori N. Surgical site infection of scrotal and inguinal lesions after urologic surgery. J Infect Chemother 2014; 20:186-9. [PMID: 24462435 DOI: 10.1016/j.jiac.2013.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 10/01/2013] [Accepted: 10/03/2013] [Indexed: 11/19/2022]
Abstract
To clarify the incidence of surgical site infection (SSI) after urological scrotal and inguinal surgical procedures and the preventive effect of antimicrobial prophylaxis for SSI, retrospective analysis was performed. The patients who underwent scrotal and inguinal operations from 2001 to 2010 were included in this analysis. A first or second generation cephalosporin was administered as antimicrobial prophylaxis just before the start of surgery and no additional prophylaxis was conducted. The surgery was classified into 76 (38%) cases with testicular sperm extraction (TESE), 72 (36%) with radical orchiectomy, 29 (14.5%) with bilateral orchiectomy (surgical castration) and 23 (11.5%) with other scrotal and inguinal operations. The median age and age range were 36 years and 18-81 years, respectively. SSI occurred in 7 (3.5%) cases. The frequencies of SSI were 6.5% in the patients with urological inguinal surgery and 1.6% in those with scrotal surgery. The frequency of SSI in the patients with urological inguinal surgery was not negligible even though it is considered a clean operation, and further analysis is warranted to prevent SSI.
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Affiliation(s)
- Teruhisa Uehara
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Satoshi Takahashi
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan.
| | - Kohji Ichihara
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yoshiki Hiyama
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Jiro Hashimoto
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yuichiro Kurimura
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Naoya Masumori
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
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Factors predicting incisional surgical site infection in patients undergoing open radical cystectomy for bladder cancer. Int J Clin Oncol 2013; 19:935-9. [DOI: 10.1007/s10147-013-0646-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 11/17/2013] [Indexed: 10/25/2022]
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17
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Tatokoro M, Kihara K, Masuda H, Ito M, Yoshida S, Kijima T, Yokoyama M, Saito K, Koga F, Kawakami S, Fujii Y. Successful reduction of hospital-acquired methicillin-resistant Staphylococcus aureus in a urology ward: a 10-year study. BMC Urol 2013; 13:35. [PMID: 23866941 PMCID: PMC3720197 DOI: 10.1186/1471-2490-13-35] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Accepted: 07/04/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND To eradicate hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) using a stepwise infection control strategy that includes an avoidance of antimicrobial prophylaxis (AMP) based on surgical wound classification and an improvement in operative procedures in gasless single-port urologic surgery. METHODS The study was conducted at an 801-bed university hospital. Since 2001, in the urology ward, we have introduced the stepwise infection control strategy. In 2007, surveillance cultures for MRSA in all urological patients were commenced. The annual incidence of MRSA was calculated as a total number of newly identified MRSA cases per 1,000 patient days. Trend analysis was performed using a Poisson regression. RESULTS Over the study period, 139,866 patients, including 10,201 urology patients, were admitted to our hospital. Of these patients, 3,719 patients, including 134 ones in the urology ward, were diagnosed with MRSA throughout the entire hospital. Although the incidence of MRSA increased throughout the entire hospital (p = 0.002), it decreased significantly in the urology ward (p < 0.0001). Of the 134 cases, 45 (33.6%) were classified as "imported," and 89 (66.4%) as "acquired." In the urology ward, the incidence of acquired MRSA decreased significantly over time (p < 0.0001), whereas the incidence of imported MRSA did not change over time (p = 0.66). A significant decrease (p < 0.0001) in the incidence of clinically significant MRSA infection over time was found. CONCLUSIONS Stepwise infection control strategy that includes a reduction or avoidance of antimicrobial prophylaxis in minimally invasive surgery can contribute to a reduction in hospital-acquired MRSA. TRIAL REGISTRATION Current study has approved by the institutional ethical review board (No.1141).
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Affiliation(s)
- Manabu Tatokoro
- Department of Urology, Tokyo Medical and Dental University Graduate School, 1-5-45, Yushima, Bunkyo, Tokyo 113-8519, Japan
| | - Kazunori Kihara
- Department of Urology, Tokyo Medical and Dental University Graduate School, 1-5-45, Yushima, Bunkyo, Tokyo 113-8519, Japan
| | - Hitoshi Masuda
- Department of Urology, Tokyo Medical and Dental University Graduate School, 1-5-45, Yushima, Bunkyo, Tokyo 113-8519, Japan
| | - Masaya Ito
- Department of Urology, Tokyo Medical and Dental University Graduate School, 1-5-45, Yushima, Bunkyo, Tokyo 113-8519, Japan
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University Graduate School, 1-5-45, Yushima, Bunkyo, Tokyo 113-8519, Japan
| | - Toshiki Kijima
- Department of Urology, Tokyo Medical and Dental University Graduate School, 1-5-45, Yushima, Bunkyo, Tokyo 113-8519, Japan
| | - Minato Yokoyama
- Department of Urology, Tokyo Medical and Dental University Graduate School, 1-5-45, Yushima, Bunkyo, Tokyo 113-8519, Japan
| | - Kazutaka Saito
- Department of Urology, Tokyo Medical and Dental University Graduate School, 1-5-45, Yushima, Bunkyo, Tokyo 113-8519, Japan
| | - Fumitaka Koga
- Department of Urology, Tokyo Medical and Dental University Graduate School, 1-5-45, Yushima, Bunkyo, Tokyo 113-8519, Japan
| | - Satoru Kawakami
- Department of Urology, Tokyo Medical and Dental University Graduate School, 1-5-45, Yushima, Bunkyo, Tokyo 113-8519, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University Graduate School, 1-5-45, Yushima, Bunkyo, Tokyo 113-8519, Japan
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[Prospective multi-institutional analysis according to the "Japanese guidelines for prevention of perioperative infections in urological field"]. Nihon Hinyokika Gakkai Zasshi 2013; 104:505-12. [PMID: 23819362 DOI: 10.5980/jpnjurol.104.505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The "Japanese guidelines for prevention of perioperative infections in urological field" was edited by the Japanese Urological Association in 2007. They are the first Japanese guidelines for antimicrobial prophylaxis specifically to prevent perioperative infections in the urological field. We report here the results of a multicenter prospective study conducted to examine the validity and usefulness of these guidelines. PATIENTS AND METHODS The subjects were 513 patients who had undergone urological surgeries between July and September 2008 at 10 nationwide university institutions in the Japanese Society of UTI Cooperative Study Group. These surgeries were transurethral resection of bladder (TURBT), transurethral resection of prostate (TURP), adrenalectomy, nephrectomy, nephroureterectomy, radical prostatectomy and total cystectomy. Analysis was performed on patient information, surgical procedures, types and durations of administration of prophylactic antibiotic agents, and the presence of surgical site infections (SSI) and remote infections (RI). RESULTS Of 513 patients, 387 (75.4%) were administered prophylactic antibiotic agents according to the guidelines. In these patients, the incidences of SSI and RI were 5.9% and 4.1%, respectively. Multivariate analysis showed that significant factors for SSI were the surgical risk (according to the ASA physical status classification system), diabetes, and operation time, and that the only significant factor for RI was the operation time. CONCLUSIONS More large-scale study and evidences are necessary in order to demonstrate the validity and usefulness of these guidelines.
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Significance of anaerobic bacteria in postoperative infection after radical cystectomy and urinary diversion or reconstruction. J Infect Chemother 2013; 19:867-70. [PMID: 23504391 DOI: 10.1007/s10156-013-0583-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 03/05/2013] [Indexed: 10/27/2022]
Abstract
Radical cystectomy followed by urinary diversion or reconstruction (RC) is a standard treatment for patients with muscle-invasive bladder cancer. In these operations, a high frequency of complications, especially postoperative infection, has been reported. However, there have only been a few studies about postoperative anaerobic bacterial infection. To clarify the significance and role of anaerobic bacteria in postoperative infection, we retrospectively analyzed cases in which postoperative infection by these organisms developed. A total of 126 patients who underwent RC from 2006 to 2010 were included in this study. Various types of postoperative infection occurred in 66 patients. Anaerobic bacterial infections were detected with cultures for urine and blood in one case, for blood in two cases, and for surgical wound pus in four. The frequency of postoperative anaerobic bacterial infection in RC was less than that of colon surgery. However, this study revealed the possible development of a nonnegligible number of postoperative anaerobic bacterial infections. Therefore, we should consider anaerobic bacteria as possible pathogens in postoperative infection after RC.
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Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt) 2013; 14:73-156. [PMID: 23461695 DOI: 10.1089/sur.2013.9999] [Citation(s) in RCA: 698] [Impact Index Per Article: 63.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Dale W Bratzler
- College of Public Health, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma 73126-0901, USA.
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Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013; 70:195-283. [DOI: 10.2146/ajhp120568] [Citation(s) in RCA: 1364] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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22
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Togo Y, Yamamoto S, Tanaka S, Kanematsu A, Ogawa O, Miyazato M, Saito H, Arai Y, Hoshi A, Terachi T, Fukui K, Kinoshita H, Matsuda T, Yamashita M, Kakehi Y, Tsuchihashi K, Sasaki M, Ishitoya S, Onishi H, Takahashi A, Ogura K, Mishina M, Okuno H, Oida T, Horii Y, Hamada A, Okasyo K, Okumura K, Iwamura H, Nishimura K, Manabe Y, Hashimura T, Horikoshi M, Mishima T, Okada T, Sumiyoshi T, Kawakita M, Kanamaru S, Ito N, Aoki D, Kawaguchi R, Yamada Y, Kokura K, Nagai J, Kondoh N, Kajio K, Yoshimoto T. Antimicrobial prophylaxis to prevent perioperative infection in urological surgery: a multicenter study. J Infect Chemother 2013; 19:1093-101. [DOI: 10.1007/s10156-013-0631-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 05/28/2013] [Indexed: 11/30/2022]
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Hashad MME, Atta M, Elabbady A, Elfiky S, Khattab A, Kotb A. Safety of no bowel preparation before ileal urinary diversion. BJU Int 2012; 110:E1109-13. [PMID: 23167296 DOI: 10.1111/j.1464-410x.2012.11415.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED Study Type - Harm (case series) Level of Evidence 4. What's known on the subject? and What does the study add? Recent studies show no advantage of bowel preparation before ileal urinary diversion and that avoidance of bowel preparation led to early restoration of intestinal function and shorter hospital stay. However, this was not tested in a prospective comparison. The current study is a prospective comparison to test for the safety of omitting bowel preparation before ileal urinary diversion. This study also examines simultaneous effects of bowel preparation on the ileal flora and mucosa. OBJECTIVE • To evaluate the safety of no bowel preparation before ileal reconstructive procedures of the lower urinary tract, in comparison to standard 3-day bowel preparation. The present study also examines the effects of bowel preparation on small bowel wall and bacterial flora. PATIENTS AND METHODS • This study enrolled 40 patients scheduled for radical cystectomy and ileal urinary diversion, presenting to the department of urology, Alexandria University, Alexandria, Egypt during the period from January 2009 to September 2010. • Patients were prospectively randomized into two groups: Group (I) had standard 3-day bowel preparation. Group (II) had only over-night fasting before surgery. • Intra-operatively, one ml of ileal fluid was collected for bacteriological studies and an ileal wall biopsy was taken for histopathological examination. • Postoperative complications were reported for all patients using modified Clavien system. RESULTS • Both groups showed insignificant difference regarding the frequency and Clavien grade of postoperative complications (P = 0.30). • Under aerobic and anaerobic conditions, 5 cases in group (I) had bacterial overgrowth of E. coli (>105) versus none in group (II) (P = 0.04). Eight patients in group (I) had sterile ileal fluid cultures versus 18 patients (90%) in group (II). No correlation could be made between would infections and the organisms isolated in ileal fluid cultures. • Histopathological examination of ileal biopsies revealed mucosal edema and submucosal congestion in 9 cases in group (I) versus 2 cases in group (II) (P = 0.0310). CONCLUSIONS • Omitting bowel preparation before ileal urinary diversion is safe, with no added complications. • Non-preparation of the small bowel is not associated with bacterial overgrowth.
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Post-operative infection and prophylactic antibiotic administration after radical cystectomy with orthotopic neobladder urinary diversion. J Infect Chemother 2012; 18:479-84. [PMID: 22249689 DOI: 10.1007/s10156-011-0360-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Accepted: 12/12/2011] [Indexed: 10/14/2022]
Abstract
The purpose of this study was to investigate the association between prophylactic antibiotic administration (PAA) and post-operative infection in radical cystectomy with orthotopic neobladder urinary diversion carried out for patients with bladder cancer. Fifty-seven consecutive cases were analyzed retrospectively. Post-operative infections were categorized as urinary tract, wound, and remote infections. We used the antibiotics tazobactam/piperacillin (TAZ/PIPC), sulbactam/ampicillin (SBT/ABPC), flomoxef (FMOX), cefazolin (CEZ), cefotiam (CTM), and cefmetazole (CMZ). Twenty-five (43.9%) patients had post-operative infections. Five of these (8.77%) patients had wound infections, 22 (38.6%) patients had urinary tract infections, and 2 (3.51%) had remote infections. Our statistical analysis demonstrated that the patients with TAZ/PIPC used for PAA (5/18: 27.8%) had a significantly lower post-operative infection rate than patients with other antibiotics (24/39: 61.5%) (p = 0.0442). In addition, the patients with a shorter-duration PAA (within 72 h after the operation (48-72 h)) had a significantly lower rate of post-operative infections (12/33: 36.4%) than those with longer-duration PAA (longer than 72-96 h after the operation) (16/24: 66.7%) (p = 0.0239). Taken together, these results suggest that TAZ/PIPC with shorter PAA duration (within 72 h) might lead to a lower rate of post-operative infections. In conclusion, our data showed that PAA with TAZ/PIPC with a shorter duration PAA (within 72 h) might be recommended for radical cystectomy with orthotopic neobladder reconstruction. A prospective study based on our data is desirable to establish or revise guidelines for prophylactic medication for preventing post-operative infection after radical cystectomy with orthotopic neobladder urinary diversion.
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Tanaka K, Arakawa S, Miura T, Shigemura K, Nakano Y, Fujisawa M, Takahashi S, Tsukamoto T, Matsumoto T. Analysis of isolated bacteria and short-term antimicrobial prophylaxis with tazobactam–piperacillin (1:4 ratio) for prevention of postoperative infections after radical cystectomy. J Infect Chemother 2012; 18:175-9. [DOI: 10.1007/s10156-011-0317-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Accepted: 09/20/2011] [Indexed: 10/17/2022]
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Grabe M. Antibiotic prophylaxis in urological surgery, a European viewpoint. Int J Antimicrob Agents 2011; 38 Suppl:58-63. [DOI: 10.1016/j.ijantimicag.2011.09.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Pérez Arbej J, Cameo Rico M, Pérez Cameo C, Mareca Doñate R. Infección de herida quirúrgica en pacientes urológicos. Revisión de los casos registrados en cuatro años. Actas Urol Esp 2010. [DOI: 10.1016/j.acuro.2010.01.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kyoda Y, Takahashi S, Takeyama K, Masumori N, Tsukamoto T. Decrease in incidence of surgical site infections in contemporary series of patients with radical cystectomy. J Infect Chemother 2010; 16:118-22. [PMID: 20157754 DOI: 10.1007/s10156-010-0032-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Accepted: 12/29/2009] [Indexed: 11/28/2022]
Affiliation(s)
- Yuuki Kyoda
- Department of Urology, Sapporo Medical University School of Medicine, S. 1, W. 16, Chuo-ku, Sapporo, 060-8543, Japan
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Infectious complications in patients with chronic bacteriuria undergoing major urologic surgery. Urology 2009; 75:77-82. [PMID: 19931893 DOI: 10.1016/j.urology.2009.09.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Revised: 08/14/2009] [Accepted: 09/10/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To review our perioperative antibiotic management of patients with chronic bacteriuria who underwent urological procedures, and the relationship to postoperative infectious complications. METHODS Between January 2002 and January 2007, 77 patients with chronic bacteriuria underwent 94 major open procedures, including ileocystoplasty (n = 53), ileal conduit (n = 19), and pubovaginal sling placement (n = 18). Admission urine cultures were classified as "sensitive" (sensitive to admission antibiotics or no growth), "resistant" (resistant to admission antibiotics), and "unknown" (multiple unspeciated organisms present or no admission culture data available). RESULTS Our rate of multidrug resistance bacteriuria was 46.3%. There were 7 febrile urinary tract infections, 12 wound infections, 1 episode of sepsis, and no intra-abdominal abscesses, yielding an infectious complication rate of 20.2%. There was no statistical relationship between urine culture status and the rate of febrile urinary tract infections or sepsis, but wound infections were less common in patients with "sensitive" urine cultures. Of the patients who had urine cultures that demonstrated multiple unspeciated organisms, 32% were complicated by wound infections. On multivariate analysis, gender, age, and body mass index were associated with the development of infectious complications. CONCLUSIONS In a medically complex population of patients, those with neurogenic bladder and frequent catheterization undergoing major abdominal surgery, we demonstrate an infectious complication rate of 20.2%. Wound infections were as common in patients whose urine cultures revealed multiple unspeciated organisms as those that were resistant to the perioperative antibiotics, and in this population, further characterization may allow for more appropriate perioperative coverage and a decreased rate of wound infections.
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Froehner M, Brausi MA, Herr HW, Muto G, Studer UE. Complications following radical cystectomy for bladder cancer in the elderly. Eur Urol 2009; 56:443-54. [PMID: 19481861 DOI: 10.1016/j.eururo.2009.05.008] [Citation(s) in RCA: 196] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Accepted: 05/05/2009] [Indexed: 02/07/2023]
Abstract
CONTEXT The incidence of bladder cancer increases with advancing age. Considering the increasing life expectancy and the increasing proportion of elderly people in the general population, radical cystectomy will be considered for a growing number of elderly patients who suffer from muscle-invasive or recurrent bladder cancer. OBJECTIVE This article reviews contemporary complication and mortality rates after radical cystectomy in elderly patients and the relationship between age and short-term outcome after this procedure. EVIDENCE ACQUISITION A literature review was performed using the PubMed database with combinations of the following keywords cystectomy, elderly, complications, and comorbidity. English-language articles published in the year 2000 or later were reviewed. Papers were included in this review if the authors investigated any relationship between age and complication rates with radical cystectomy for bladder cancer or if they reported complication rates stratified by age groups. EVIDENCE SYNTHESIS Perioperative morbidity and mortality are increased and continence rates after orthotopic urinary diversion are impaired in elderly patients undergoing radical cystectomy. Complications are frequent in this population, particularly when an extended postoperative period (90 d instead of 30 d) is considered. CONCLUSIONS Although age alone does not preclude radical cystectomy for muscle-invasive or recurrent bladder cancer or for certain types of urinary diversion, careful surveillance is required, even after the first 30 d after surgery. Excellent perioperative management may contribute to the prevention of morbidity and mortality of radical cystectomy, supplementary to the skills of the surgeon, and is probably a reason for the better perioperative results obtained in high-volume centers.
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Affiliation(s)
- Michael Froehner
- Department of Urology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany.
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Sawai J, Okamura T, Naiki T, Hijikata Y, Oe H, Sawa M, Hyodo M, Inatomi R, Okudaira M, Naito A, Inuzuka K. Risk Factors for Surgical Site Infection (SSI) after Urological Surgery: Incisional and Deep-organ/space Experience at Anjo Hospital. J Rural Med 2009. [DOI: 10.2185/jrm.4.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Ramos A, Asensio A, Muñez E, Torre-Cisneros J, Montejo M, Aguado JM, Cofán F, Carratalá J, Len O, Cisneros JM. Incisional Surgical Site Infection in Kidney Transplantation. Urology 2008; 72:119-23. [DOI: 10.1016/j.urology.2007.11.030] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2007] [Revised: 10/18/2007] [Accepted: 11/08/2007] [Indexed: 11/16/2022]
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Stojadinovic MM, Mićić SR, Milovanović DR. Predictors of surgical site infection in dirty urological surgery. Int J Urol 2008; 15:699-703. [PMID: 18522677 DOI: 10.1111/j.1442-2042.2008.02083.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Risk factors for surgical site infection (SSI) following urologic dirty operations have not been clearly identified. This study was conducted to describe incidence, potential risk factors and common causative pathogens of the SSI in such operations. METHODS Medical records of patients who had undergone simple nephrectomy or lumbotomy for suppurative renal infection at our institutions from 1999 to 2006 were retrospectively evaluated. The following data were retrieved: presence of SSI, demographic data, laboratory findings, comorbidities, microbiological data, type of renal suppuration, type of urological surgery and antibiotic regimen. Risk factors for SSI were evaluated using the multiple logistic regression model. RESULTS Sixty-five patients (mean age 55.6 +/- 13.1 years) were eligible for data analysis. In 20 of them (30.8%) a SSI was identified. The most common isolated pathogens were gram-negative bacteria. At univariate logistic regression analysis risk factors significantly associated with SSI included: presence of emphysematous infection, hypoalbuminemia, number of predisposing conditions, emergency operations, isolation of Enterobacteriaceae, positive pus culture. The use of trimethoprim/sulfamethoxazole was associated with a decreased risk for SSI. Multiple logistic model identified only the emergency operations and isolated Enterobacteriaceae as independent predictors of SSI (odds ratio [OR] = 11.1) (95% confidence interval [CI] = 3.0-40.8) and OR = 3.9 (1.0-14.8), respectively. CONCLUSIONS Patients with suppurative renal infections are submitted to life-saving emergency surgery. Urological surgeons should keep in mind that this carries a high risk for subsequent SSI. Effective preventive measures in these circumstance cannot be identified. Further research in this area is necessary to clarify this issue.
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Affiliation(s)
- Miroslav M Stojadinovic
- Department of Urology, Clinic of Urology and Nephrology, Clinical Centre Kragujevac, Zmaj Jovina 30, 34 000 Kragujevac, Serbia.
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Yamamoto S, Shima H, Matsumoto T. Controversies in perioperative management and antimicrobial prophylaxis in urologic surgery. Int J Urol 2008; 15:467-71. [DOI: 10.1111/j.1442-2042.2008.02051.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hara N, Kitamura Y, Saito T, Komatsubara S, Nishiyama T, Takahashi K. Perioperative antibiotics in radical cystectomy with ileal conduit urinary diversion: Efficacy and risk of antimicrobial prophylaxis on the operation day alone. Int J Urol 2008; 15:511-5. [DOI: 10.1111/j.1442-2042.2008.02050.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Botía Martinez F, Blanco Zamora J, López Sánchez A, Pérez Albacete M, Jordana MC. Análisis de los factores de riesgo asociados a infección quirúrgica en un servicio de urología. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/s1134-282x(07)71199-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ballestero Diego R, Rebollo Rodrigo H, Gutiérrez Baños J, Aguilera Tubet C, Zubillaga Guerrero S, Martín García B. Infección nosocomial y del sitio quirúrgico en un hospital de tercer nivel (2002-2005). Actas Urol Esp 2006. [DOI: 10.1016/s0210-4806(06)73557-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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