Risk for Clostridium difficile infection after radical cystectomy for bladder cancer: Analysis of a contemporary series.
BACKGROUND
This study seeks to evaluate the incidence and associated risk factors of Clostridium difficile infection (CDI) in patients undergoing radical cystectomy (RC) for bladder cancer.


METHODS
We retrospectively reviewed a single institution׳s bladder cancer database including all patients who underwent RC between 2010 and 2013. CDI was diagnosed by detection of Clostridium difficile toxin B gene using polymerase chain reaction-based stool assay in patients with clinically significant diarrhea within 90 days of the index operation. A multivariable logistic regression model was used to identify demographics and perioperative factors associated with developing CDI.


RESULTS
Of the 552 patients who underwent RC, postoperative CDI occurred in 49 patients (8.8%) with a median time to diagnosis after RC of 7 days (interquartile range: 5-19). Of the 122 readmissions for postoperative complications, 10% (n = 12) were related to CDI; 2 patients died of sepsis directly related to severe CDI. On multivariate logistic regression, the use of chronic antacid therapy (odds ratio = 1.9, 95% CI: 1.02-3.68, P = 0.04) and antibiotic exposure greater than 7 days (odds ratio = 2.2, 95% CI: 1.11-4.44, P = 0.02) were independently associated with developing CDI. The use of preoperative antibiotics for positive findings on urine culture within 30 days before surgery was not statistically significantly associated with development of CDI (P = 0.06).


CONCLUSIONS
The development of CDI occurs in 8.8% of patients undergoing RC. Our study demonstrates that use of chronic antacid therapy and long duration of antimicrobial exposure are associated with development of CDI. Efforts focusing on minimizing antibiotic exposure in patients undergoing RC are needed, and perioperative antimicrobial prophylaxis guidelines should be followed.
Department of Urology, Indiana University Health, Indianapolis, IN. Electronic address: mkoch2@iuhealth.org.
Nick W
NW
Liu
Department of Urology, Indiana University Health, Indianapolis, IN.
Kashyap
K
Shatagopam
Department of Urology, Indiana University Health, Indianapolis, IN.
M Francesca
MF
Monn
Department of Urology, Indiana University Health, Indianapolis, IN.
Hristos Z
HZ
Kaimakliotis
Department of Urology, Indiana University Health, Indianapolis, IN.
Clint
C
Cary
Department of Urology, Indiana University Health, Indianapolis, IN.
Ronald S
RS
Boris
Department of Urology, Indiana University Health, Indianapolis, IN.
Matthew J
MJ
Mellon
Department of Urology, Indiana University Health, Indianapolis, IN.
Timothy A
TA
Masterson
Department of Urology, Indiana University Health, Indianapolis, IN.
Richard S
RS
Foster
Department of Urology, Indiana University Health, Indianapolis, IN.
Thomas A
TA
Gardner
Department of Urology, Indiana University Health, Indianapolis, IN.
Richard
R
Bihrle
Department of Urology, Indiana University Health, Indianapolis, IN.
Michael G
MG
House
Department of Urology, Indiana University Health, Indianapolis, IN.
Michael O
MO
Koch
D000368:Aged; D016360:Clostridioides difficile / Q000166:cytology / Q000378:metabolism*; D015653:Cystectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D001749:Urinary Bladder Neoplasms / Q000150:complications* / Q000601:surgery*
Bladder cancer; Clostridium difficile; Infection; Radical cystectomy; Urinary diversions