Post-Cystectomy UTI Risk Linked to Comorbidities
Patients with a heavy comorbidity burden are at higher risk of urinary tract infection after radical cystectomy.
Urinary tract infection (UTI) is a frequent complication and cause of hospital readmission following radical cystectomy (RC) and urinary diversion, according to a new study.
Hooman Djaladat, MD, MS, of the University of Southern California Institute of Urology in Los Angeles, and colleagues analyzed data from 1133 patients who underwent RC for bladder cancer from 2003 to 2013. Of these, 815 (72%) underwent orthotopic diversion, 274 (24%) ileal conduit and 44 (4%) continent cutaneous diversion. A total of 123 (11%) patients experienced 151 documented UTIs during the first 90 days post-operatively, Dr Djaladat's team reported online ahead of print in the World Journal of Urology. Of these, 21 (17%) had multiple infections and 25 (20%) had urosepsis during that period. The most common etiology was Gram-negative rods (54% of positive cultures). The most commonly identified bacteria were Escherichia coli, Enterococcus faecalis, and Klebsiella pneumoniae. The median time to infection was 20 days.
In addition, results showed that 52% of UTI episodes led to readmission. The investigators found no significant difference in etiologic microbiology, or antibiotic sensitivity and resistance among the diversion types. Quinolone resistance was documented in 87.5% of Gram-positive and 35% of Gram-negative bacteria. On multivariable analysis, a Charlson Comorbidity Index score of 2 or more was independently associated with 80% greater odds of any UTI and 5.6-fold greater odds of Candida UTI compared with a score of 0. Urinary diversion type was not independently associated with UTI.
Clifford TG, Katebian B, Van Horn CM et al. Urinary tract infections following radical cystectomy and urinary diversion: a review of 1133 patients. World J Urol. 2018 Jan 25. Doi: 10.1007/s00345-018-2181-2.