title: Use and outcomes of extended antibiotic prophylaxis in urological cancer surgery.
abstract: OBJECTIVE
  Although perioperative antibiotic prophylaxis prevents postoperative infectious complications, national guidelines recommend cessation of antibiotics within 24 hours after the procedure. Extended antibiotic prophylaxis beyond 24 hours may contribute to hospital acquired infections such as Clostridium difficile colitis. We evaluated practice patterns of antibiotic prophylaxis in genitourinary cancer surgery and assessed the impact of antibiotic prophylaxis on hospital acquired C. difficile infections.
  
  
  METHODS
  We identified 59,184 patients treated with radical prostatectomy, 27,921 who underwent partial or radical nephrectomy, and 5,425 treated with radical cystectomy for prostate, kidney and bladder cancers, respectively, from the Premier Perspective Database (Premier Inc., Charlotte, North Carolina) from 2007 to 2012. We constructed hierarchical linear regression models to identify patient and hospital factors associated with extended antibiotic prophylaxis. We evaluated the association between extended antibiotic prophylaxis and C. difficile infections for patients who underwent partial or radical nephrectomy and radical cystectomy with multivariate logistic regression.
  
  
  RESULTS
  Surgery specific models demonstrated that hospital identity was associated with a substantial proportion of the variation in extended antibiotic prophylaxis (20% to 35% for radical prostatectomy, partial or radical nephrectomy, and radical cystectomy). Postoperative C. difficile colitis occurred in 0.02% of patients treated with radical prostatectomy, 0.23% of those treated with partial or radical nephrectomy and 1.7% of those treated with radical cystectomy. On multivariate analysis extended antibiotic prophylaxis was associated with higher odds of C. difficile infection after partial or radical nephrectomy (OR 3.79, 95% CI 2.46-5.84) and radical cystectomy (OR 1.64, 95% CI 1.12-2.39).
  
  
  CONCLUSIONS
  Antibiotics may be overused after genitourinary cancer surgery and this overuse is associated with hospital acquired C. difficile colitis. Efforts are needed to encourage greater compliance with evidence-based approaches to postoperative care.
authors.affiliation: Department of Urology, University of Washington, Seattle, Washington.
authors.forename: Joshua K
authors.initials: JK
authors.lastname: Calvert
authors.affiliation: Department of Urology, University of Washington, Seattle, Washington.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Holt
authors.affiliation: Department of Urology, University of Washington, Seattle, Washington.
authors.forename: Matthew
authors.initials: M
authors.lastname: Mossanen
authors.affiliation: Department of Urology, University of Washington, Seattle, Washington.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: James
authors.affiliation: Department of Urology, University of Washington, Seattle, Washington; Division of Urology, VA Puget Sound Health Care System, Seattle, Washington.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Wright
authors.affiliation: Department of Urology, University of Washington, Seattle, Washington; Division of Urology, VA Puget Sound Health Care System, Seattle, Washington.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Porter
authors.affiliation: Department of Urology, University of Washington, Seattle, Washington. Electronic address: jlgore@u.washington.edu.
authors.forename: John L
authors.initials: JL
authors.lastname: Gore
mesh_terms: D019072:Antibiotic Prophylaxis / Q000379:methods; D015653:Cystectomy; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D009392:Nephrectomy; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000601:surgery*
keywords: antibiotic prophylaxis; cross infection; kidney neoplasms; prostatic neoplasms; urinary bladder neoplasms