Urinary tract infections in patients with orthotopic neobladder.
OBJECTIVE
Orthotopic neobladder urinary diversion is associated with a high rate of infectious complications, especially in the early postoperative period. The aim of the study was to assess the incidence, associated pathogens, and predictors of symptomatic urinary tract infection (UTI) in patients with an orthotopic neobladder.


METHODS
The medical records of 79 patients treated with radical cystectomy and orthotopic neobladder urinary diversion at a tertiary medical center in 2004 to 2012 were reviewed for data pertaining to bacteriuria and symptomatic UTI after hospital discharge. Cumulative incidences of clinical events were assessed with the Kaplan-Meier method. Univariate and multivariate Cox regression models were used to identify clinical predictors of infection.


RESULTS
A total of 69 men and 10 women were included in the study cohort. The estimated cumulative rates of symptomatic UTI were 34% at 3 months, 40% at 6 months, and 43% at 12 months. New events of symptomatic UTI occurred in 36% of the patients during the first 3 postoperative months, but only in 10% at 3 to 6 months and 8% at 6 to 12 months. Common pathogens were Pseudomonas aeruginosa (24%) and Escherichia coli (24%); 78% of bacterial pathogens were susceptible to amikacin. On multivariate analysis, there was no effect of age, gender, intermittent catheterization, bowel segment used for reconstruction, or perioperative chemotherapy on rates of UTI.


CONCLUSIONS
Symptomatic UTI is a common complication after neobladder reconstruction, usually occurring within the first 3 months of surgery. P. aeruginosa infection is common. Inpatient empirical treatment with amikacin is recommended in this setting.
Department of Urology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: roymano78@gmail.com.
Roy
R
Mano
Department of Urology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Jack
J
Baniel
Department of Urology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Hanan
H
Goldberg
Department of Urology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Yariv
Y
Stabholz
Department of Urology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Daniel
D
Kedar
Department of Urology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Ofer
O
Yossepowitch
D000368:Aged; D000583:Amikacin / Q000494:pharmacology; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001424:Bacterial Infections / Q000209:etiology / Q000382:microbiology*; D015331:Cohort Studies; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods; D004926:Escherichia coli / Q000187:drug effects / Q000302:isolation & purification; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000209:etiology / Q000382:microbiology; D016016:Proportional Hazards Models; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000302:isolation & purification; D062606:Tertiary Care Centers; D001743:Urinary Bladder / Q000601:surgery; D014547:Urinary Diversion / Q000009:adverse effects* / Q000379:methods; D016476:Urinary Reservoirs, Continent / Q000009:adverse effects*; D014552:Urinary Tract Infections / Q000209:etiology / Q000382:microbiology*
D000900:Anti-Bacterial Agents; D000583:Amikacin
Bladder cancer; Orthotopic urinary diversion; Radical cystectomy; Urinary tract infection; Urosepsis