Association Between Antibiotic Prophylaxis Before Cystectomy or Stent Removal and Infection Complications: A Systematic Review

被引：15

作者：

Antonelli, Luca ^{[1
,2
]}

Sebro, Kirby ^{[3
]}

Lahmar, Abdelilah ^{[4
]}

Black, Peter C. ^{[5
,6
]}

Ghodoussipour, Saum ^{[7
]}

Hamilton-Reeves, Jill M. ^{[8
]}

Shah, Jay ^{[9
]}

Thoft, Jensen Bente ^{[10
]}

Lerner, Seth Paul ^{[11
]}

Llorente, Carlos ^{[12
,13
]}

Lucca, Ilaria ^{[14
]}

Preston, Mark A. ^{[15
,16
]}

Psutka, Sarah P. ^{[17
]}

Sfakianos, John P. ^{[18
]}

Lauridsen, Susanne Vahr ^{[19
,20
,21
]}

Williams, Stephen B. ^{[22
]}

Catto, James ^{[23
]}

Djaladat, Hooman ^{[24
]}

Kassouf, Wassim ^{[25
]}

Loftus, Katherine ^{[26
]}

Daneshmand, Siamak ^{[27
]}

Fankhauser, Christian D. ^{[1
]}

机构：

[1] Univ Lucerne, Dept Urol, Luzerner Kantonsspital, Luzern, Switzerland

[2] Sapienza Univ, Dept Urol, Policlin Umberto 1, Rome, Italy

[3] Western Gen Hosp, Dept Urol, Edinburgh, Scotland

[4] Mohammed VI Univ Hosp, Fac Med & Pharm, Med, Oujda, Morocco

[5] Univ British Columbia, Vancouver Prostate Ctr, Vancouver, BC, Canada

[6] Univ British Columbia, Dept Urol Sci, Vancouver, BC, Canada

[7] Rutgers Canc Inst New Jersey, Sect Urol Oncol, New Brunswick, NJ USA

[8] Univ Kansas Med Ctr, Dept Urol, Kansas City, KS USA

[9] Stanford Univ, Dept Urol, Sch Med, Stanford, CA USA

[10] Aarhus Univ Hosp, Dept Urol, Aarhus, Denmark

[11] Baylor Coll Med, Dan L Duncan Canc Ctr, Scott Dept Urol, Houston, TX USA

[12] Hosp Univ Fdn Alcorcon, Dept Urol, Alcorcon, Madrid, Spain

[13] Hosp Univ Fdn Alcorcon, Res Unit, Alcorcon, Madrid, Spain

[14] CHU Vaudois, Dept Urol, Lausanne, Switzerland

[15] Harvard Med Sch, Brigham & Womens Hosp, Div Urol Surg, Boston, MA USA

[16] Harvard Med Sch, Brigham & Womens Hosp, Ctr Surg & Publ Hlth, Boston, MA USA

[17] Univ Washington, Dept Urol, Seattle, WA USA

[18] Icahn Sch Med Mt Sinai, Dept Urol, New York, NY USA

[19] Copenhagen Univ Hosp, Dept Urol, Copenhagen, Denmark

[20] Parker Inst Bispebjerg, WHO CC, Copenhagen, Denmark

[21] Frederiksberg Univ Hosp, Copenhagen, Denmark

[22] Univ Texas Med Branch, Dept Surg, Div Urol, Galveston, TX USA

[23] Univ Sheffield, Acad Urol Unit, Sheffield, England

[24] Univ Southern Calif, Inst Urol, Kenneth Norris Jr Comprehens Canc Ctr, Los Angeles, CA USA

[25] McGill Univ, Fac Med, Dept Surg Urol, Montreal, PQ, Canada

[26] Icahn Sch Med Mt Sinai, Dept Anesthesiol Perioperat & Pain Med, New York, NY USA

[27] Univ Southern Calif, Keck Sch Med, Dept Urol, Los Angeles, CA USA

来源：

EUROPEAN UROLOGY FOCUS | 2023年 / 9卷 / 04期

关键词：

Cystectomy; Infection; Postoperative complications; Antibiotic prophylaxis; Sepsis; RADICAL CYSTECTOMY; ANTIMICROBIAL PROPHYLAXIS; EFFICACY; RISK;

D O I：

10.1016/j.euf.2023.01.012

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

1002 ; 100201 ;

摘要：

Context: Patients undergoing radical cystectomy frequently suffer from infectious com-plications, including urinary tract infections (UTIs) and surgical site infections (SSIs) leading to emergency department visits, hospital readmission, and added cost.Objective: To summarize the literature regarding perioperative antibiotic prophylaxis, ureteric stent usage, and prevalence of infectious complications after cystectomy.Evidence acquisition: A systematic review of PubMed/Medline, EMBASE, Cochrane Library, and reference lists was conducted. Evidence synthesis: We identified 20 reports including a total of 55 306 patients. The median rates of any infection, UTIs, SSIs, and bacteremia were 40%, 20%, 11%, and 6%, respectively. Perioperative antibiotic prophylaxis differed substantially between reports. Perioperative antibiotics were used only during surgery in one study but were continued over several days after surgery in all other studies. Empirical use of antibiotics for 1-3 d after surgery was described in 12 studies, 3-10 d in two studies, and >10 d in four studies. Time to stent removal ranged from 4 to 25 d after cystectomy. Prophylactic antibiotics were used before stent removal in nine of 20 studies; two of these studies used targeted antibiotics based on urine cultures from the ureteric stents, and the other seven studies used a single shot or 2 d of empirical antibiotics. Studies with any prophy-lactic antibiotic before stent removal found a lower median percentage of positive blood cultures after stent removal than studies without prophylactic antibiotics before stent removal (2% vs 9%).Conclusions: We confirmed a high proportion of infectious complications after cystec-tomy, and a heterogeneous pattern of choice and duration of antibiotics during and after surgery or stent removal. These findings highlight a need for further studies and support quality prospective trials.Patient summary: In this review, we observed wide variability in the use of antibiotics before or after surgical removal of the bladder.& COPY; 2023 The Author(s). Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4.0/).

引用

页码：631 / 636

页数：6

共 44 条

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