Mp63-03 the Optimal Antibiotic Prophylaxis for Radical Cystectomy: a Population-based Analysis
Year: 2016
Type: article
Study design: Observational Study
Abstract: You have accessJournal of UrologyBladder Cancer: Invasive V1 Apr 2016MP63-03 THE OPTIMAL ANTIBIOTIC PROPHYLAXIS FOR RADICAL CYSTECTOMY: A POPULATION-BASED ANALYSIS Ross Krasnow, Sophia Koo, David Kubiak, Francisco Gelpi-Hammerschmidt, Mark Preston, Benjamin Chung, Adam Kibel, and Steven Chang Ross KrasnowRoss Krasnow More articles by this author , Sophia KooSophia Koo More articles by this author , David KubiakDavid Kubiak More articles by this author , Francisco Gelpi-HammerschmidtFrancisco Gelpi-Hammerschmidt More articles by this author , Mark PrestonMark Preston More articles by this author , Benjamin ChungBenjamin Chung More articles by this author , Adam KibelAdam Kibel More articles by this author , and Steven ChangSteven Chang More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.932AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radical cystectomy (RC) is a morbid operation with a high complication rate. We aimed to identify the prophylactic antibiotic regimen with the lowest rate of infectious and soft-tissue complications among patients undergoing RC. METHODS We conducted a population-based, retrospective cohort study of patients who underwent RC for bladder cancer across the USA between 2003 to 2013 using the Premier Hospital Database. The perioperative antibiotics administered on the day of surgery and the duration of therapy was captured. ICD-9 codes identified infectious and soft tissue complications ( (e.g., wound infection, UTI, sepsis, C. difficile) that occurred during the index admission or on readmission within 90 days. A multivariable logistic regression model controlling for patient and hospital characteristics assessed the relationship between the prophylactic antibiotic regimen and subsequent development of SSTE and non-SSTE. RESULTS The study cohort was comprised of 8,294 patients, representing a survey-weighted cohort of 51,828, who underwent RC. The overall non-SSTE and SSTE rate was 28.5%. The 3 most common regimens were 1st generation cephalosporin (22.7%), a 2nd generation cephalosporin (13.2%), and a quinolone (5.8%) as a single-agent, but 50% of the patients received ≥2 antibiotics. On multivariable analysis, receiving >1 antibiotic on the day of surgery was associated with a decrease in infectious complications (OR 0.7 [0.6-0.8] p=<0.001) as was extended duration beyond post-operative day 1 (OR 0.8 [0.7-1.0], p=0.013). When compared to 1st generation cephalosporin monotherapy, the odds of any event were significantly lower with a 1st generation cephalosporin or penicillin in combination with an aminoglycoside or 2nd/3rd generation cephalosporin (OR 0.5 [0.4-0.7], p<0.001). Other antibiotic monotherapy or combinations performed similarly to 1st generation cephalosporin monotherapy (OR 1.1 [0.9-1.3], p=0.36 and OR 0.8 [0.7-1.1], p=0.12). CONCLUSIONS In the study, the optimal antibiotic prophylaxis for patients undergoing radical cystectomy was combination therapy with 1st generation cephalosporin or penicillin with an aminoglycoside or 2nd/3rd generation cephalosporin. The ideal antibiotic regimen and duration should be further studied to optimize perioperative outcomes. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e822 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Ross Krasnow More articles by this author Sophia Koo More articles by this author David Kubiak More articles by this author Francisco Gelpi-Hammerschmidt More articles by this author Mark Preston More articles by this author Benjamin Chung More articles by this author Adam Kibel More articles by this author Steven Chang More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
Source: The Journal of Urology
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2314954892