Research Shows 24-Hour Antibiotic Prophylaxis Prevents Surgical Infections in Cystectomy

"These findings demonstrate that 24-hour perioperative antibiotic prophylaxis (PAP) is noninferior to extended PAP in preventing SSIs, potentially helping to minimize unnecessary prolonged antibiotic exposure," the researchers wrote in JAMA Network Open.

Surgical site infections are a common complication following major surgeries, including cystectomy, where the bladder is removed and urinary diversion is performed. Traditionally, extended durations of antibiotic prophylaxis have been used to reduce the risk of SSIs. However, the unnecessary use of antibiotics can contribute to antibiotic resistance, therefore, it is crucial to evaluate the effectiveness of shorter treatment courses.

PAP effectively reduces the risk of surgical site infections. While guidelines suggest 24 hours or less for PAP in cystectomy with urinary diversion, there is a lack of evidence regarding the optimal duration for this procedure, leading to the common practice of prolonged administration of PAP.

To address this knowledge gap, Maria C. Thurnheer, University of Bern, Bern, Switzerland, and colleagues aimed to determine if 24-hour PAP is noninferior to extended-duration PAP in preventing surgical site infections within 90 days following cystectomy with urinary diversion.

For this purpose, the researchers conducted a single-center, noninferiority randomized clinical trial from April 18, 2018, to August 18, 2022, involving patients over 18 undergoing elective open cystectomy with urinary diversion. Patients with contraindications to the drugs or who could not follow study procedures were excluded.

Participants were assigned to receive either 24 hours of perioperative antibiotic prophylaxis or extended PAP until all catheters and stents were removed. The primary outcome measured was the rate of surgical site infections, while secondary outcomes included all-cause mortality within 90 days after surgery. The study assessed the noninferiority of the 24-hour PAP by comparing the 90% confidence interval with a predefined noninferiority margin of 10%.

The study led to the following findings:

• Ninety-five patients were assigned to the 24-hour PAP group (median age 69.3 years; 69.5% male), and ninety-eight patients to the extended PAP group (median age 69.5 years; 69.4% male).
• The 24-hour PAP group received prophylaxis for a median of 1 day, while the extended group received it for eight days.
• No significant differences in surgical site infections within 90 days were observed, with 8.4% of patients in the 24-hour group and 12.2% in the extended group.
• The risk difference for the cumulative incidence of SSI at 90 days was −3.8%, confirming the noninferiority of 24-hour PAP compared to extended PAP in preventing SSIs.
• There was no significant difference in mortality rates between the two groups.

"To our knowledge, this randomized clinical trial is the first to offer high-quality evidence that 24-hour PAP is noninferior to extended PAP in preventing surgical site infections within 90 days after cystectomy and urinary diversion. These findings could significantly support antibiotic stewardship efforts in urology," the researchers concluded.

Reference:

Thurnheer MC, Schürmann A, Huber M, Marschall J, Wuethrich PY, Burkhard FC. Perioperative Antibiotic Prophylaxis Duration in Patients Undergoing Cystectomy With Urinary Diversion: A Randomized Clinical Trial. JAMA Netw Open. 2024;7(10):e2439382. doi:10.1001/jamanetworkopen.2024.39382