title: Post-operative infection and prophylactic antibiotic administration after radical cystectomy with orthotopic neobladder urinary diversion.
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.
authors.affiliation: Department of Urology, Shinko Hospital, 1-4-47 Wakihama-cho, Chuo-ku, Kobe, Hyogo, 651-0072, Japan. yutoshunta@hotmail.co.jp
authors.forename: Katsumi
authors.initials: K
authors.lastname: Shigemura
authors.forename: Kazushi
authors.initials: K
authors.lastname: Tanaka
authors.forename: Minori
authors.initials: M
authors.lastname: Matsumoto
authors.forename: Yuzo
authors.initials: Y
authors.lastname: Nakano
authors.forename: Toshiro
authors.initials: T
authors.lastname: Shirakawa
authors.forename: Masahiro
authors.initials: M
authors.lastname: Miyata
authors.forename: Masuo
authors.initials: M
authors.lastname: Yamashita
authors.forename: Soichi
authors.initials: S
authors.lastname: Arakawa
authors.forename: Masato
authors.initials: M
authors.lastname: Fujisawa
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D016009:Chi-Square Distribution; D015653:Cystectomy / Q000009:adverse effects*; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010397:Penicillanic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010878:Piperacillin / Q000627:therapeutic use; D000077725:Piperacillin, Tazobactam Drug Combination; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control*; D014547:Urinary Diversion / Q000009:adverse effects*; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents; D000077725:Piperacillin, Tazobactam Drug Combination; D010397:Penicillanic Acid; D010878:Piperacillin