Login to Access Video or Poster Abstract: MP23-16
Sources of Funding: none

Introduction

Radical cystectomy with intestinal urinary diversion has the high incidence of post-operative infective complication. Some patients encountered febrile urinary tract infection (UTI) after removal of the ureteral stents. We started targeted antibiotic prophylaxis, which was chosen appropriate susceptible antibiotics based on urine culture. We evaluated the efficacy of the targeted antibiotic prophylaxis for prevention of febrile UTI after removal of the ureteral stents.

Methods

From January 2009 to April 2016, a total of 54 patients who underwent radical cystectomy with intestinal urinary diversion were included. In the first half of the study period (January 2009 to December 2011) included 21 patients, ureteral stents were removed without administration of antibiotic agent. In the last half (January 2012 to April 2016) included 33 patients, targeted antibiotic prophylaxis was done. Prior to removal ureteral stents on post-operative day 7, urine obtained from ureteral stents was cultured and determined the susceptibility of isolated bacteria. Patient received antibiotics for which the isolates were susceptible before the stent removal. Patients were followed up for 2 weeks and febrile UTI were recorded. We compared the incidence of febrile UTI between two study periods.

Results

Overall the incidence of febrile UTI after stent removal was 22.2% (12/54). In the first half of the study period, the incidence of febrile UTI was 47.6% (10/21) and that of in the last half was 6.1% (2/33). The incidence of febrile UTI was significantly decreased in the last half period (Fisher&[prime]s test, p=0.006). _x000D_ Urine cultures positive for bacteria were found in 29 out of 33 patients in the last half period and 33 strains of 11 bacteria species were isolated. The predominant bacteria were E.coli in 5 patients, S. aureus in 4 patients, K.peumoniae in 4 patients and E.cloacae in 4 patients. Five strains (15.2%) of methicillin resistant Staphyococci, 2 strains (6.1%) of extended spectrum β-lactamase producing bacteria and 14 strains (42.4%) of fluoroquinolone-resistant bacteria were isolated._x000D_

Conclusions

The susceptibility test had an advantage of appropriate antibiotics choice, because 29 out of 33 patients had urine cultures positive for bacteria and miscellaneous and drug-resistant strains were isolated. This targeted antibiotic choice based on urine culture is more effective prophylaxis in radical cystectomy patients.

Funding

none