Most patients who undergo radical cystectomy with ileal conduit (RCIC) do not receive antibiotic prophylaxis that follow American Urological Association (AUA) guidelines, investigators reported at the Society of Urologic Oncology’s 23rd annual meeting in San Diego, California.
Using the Premier Healthcare Database, Megan Prunty, MD, of Case Western Reserve University School of Medicine in Cleveland, Ohio, and colleagues identified 6708 patients undergoing RCIC from 2015 to 2020. Of these, only 27% received guidelines-based antibiotic prophylaxis.
Compared with patients who did not receive guidelines-based antibiotic prophylaxis for radical cystectomy, those who did were significantly less likely to be diagnosed with a urinary tract infection (21% vs 24%), pyelonephritis (5.1% vs 7.7%), bacterial infection (24% vs 27%), and pneumonia (12% vs 17%), the investigators reported in a study abstract. They observed no significant difference between the groups with respect to Clostridium difficile infection (3.2% vs 3.7%).
On multivariable analysis, Medicare and Medicaid coverage were significantly associated with 30% and 48% increased odds of infectious events, respectively, compared with commercial insurance, Dr Prunty and colleagues reported. Self-pay patients had significant 84% increased odds.
Non-guideline prophylaxis was significantly associated with 27% increased odds of infectious events. Robotic-assisted radical cystectomy was significantly associated with 18% lower odds of infectious events, according to the investigators.
“While residual confounding is possible, these data support current AUA guidelines, and suggest a need for outreach to improve guideline adherence,” the authors concluded.
Prunty M, Rhodes S, Callegari M, et al. National adherence to guidelines for antimicrobial prophylaxis for patients undergoing radical cystectomy. Presented at: SUO 2022, November 30 to December 2, San Diego, California. Poster 8.