Preoperative antibiotics tied to increased risk of infection after radical cystectomy: Study

USA: In a new study conducted by Craig V. Labbate and the team, it was shown that outpatient antibiotic usage is prevalent prior to radical cystectomy and may be related to an increase in the risk of postoperative infection and readmission. The findings of this study were published in Urology, on 22nd February 2022.

The following work was conducted with an objective to assess antibiotic exposure rates before radical cystectomy and whether there is an association with postoperative infections. In order to achieve the study goal, in the 2016 SEER-Medicare linkage, 2248 patients with complete prescription information who underwent radical cystectomy between 2008 and 2014 were found. Exposure was defined as an outpatient prescription for an antibiotic within 30 days of the cystectomy. The antibiotic class and combinations were documented. Within 30 days following cystectomy, infection diagnoses and readmissions were recorded.

The results of this study stated as follow:

1. Prior to cystectomy, 51% of patients (n = 1149) were given an outpatient antibiotic.

2. Patients getting antibiotics were more likely to be female (31% vs 25%) and to have been diagnosed with an infection (17% vs 11%).

3. Antibiotic bowel prophylaxis was recommended for 42% of antibiotic-treated individuals.

4. The exposure group had a higher incidence of any infection (56% vs 51%) and UTI (36% vs 31%) postoperatively.

5. The exposure cohort had a greater rate of all-cause readmission within 30 days (26% vs 22%).

6. Outpatient preoperative antibiotics were found to be an independent risk factor for any infection (HR 1.19) and readmission (hazards ratio 1.24) in the 30 days following radical cystectomy using multivariable logistic regression.

In conclusion, antibiotics should be used with caution prior to radical cystectomy since they appear to be related to an increased risk of postoperative infection and hospital readmissions. Antibiotic usage before radical cystectomy should be investigated as a controllable factor in order to reduce postoperative morbidity.

Reference:

Labbate, C. V., Kuchta, K., Park, S., Agarwal, P. K., & Smith, N. D. (2022). Incidence of Preoperative Antibiotic Use and Its Association with Postoperative Infectious Complications after Radical Cystectomy. In Urology. Elsevier BV. https://doi.org/10.1016/j.urology.2022.01.048

Keywords: Radical cystectomy, infection, morbidity, antibiotics, complications, adverse events, surgery, UTI, hospitalization, Urology,