Mp22-19 Post-Operative Antibiotic Prophylaxis in Radical Cystectomy Patients Reduces Gu Infections

You have accessJournal of UrologyBladder Cancer: Invasive II (MP22)1 May 2024MP22-19 POST-OPERATIVE ANTIBIOTIC PROPHYLAXIS IN RADICAL CYSTECTOMY PATIENTS REDUCES GU INFECTIONS Randie E. White, Joshua A. Linscott, Erin Santos, Connor Pelletier, Stephen T. Ryan, Matthew T. Hayn, Jeffrey E. Howard, Evelyn James, and Jesse D. Sammon Randie E. WhiteRandie E. White , Joshua A. LinscottJoshua A. Linscott , Erin SantosErin Santos , Connor PelletierConnor Pelletier , Stephen T. RyanStephen T. Ryan , Matthew T. HaynMatthew T. Hayn , Jeffrey E. HowardJeffrey E. Howard , Evelyn JamesEvelyn James , and Jesse D. SammonJesse D. Sammon View All Author Informationhttps://doi.org/10.1097/01.JU.0001008608.50694.4b.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical Cystectomy (RC) is a morbid procedure with frequent readmissions. Our prior work identified readmission due to genitourinary (GU) infections as a target for improvement. Here we developed an RC-specific antibiogram to guide antibiotic prophylaxis (ppx) and assess implementation. METHODS: Data was extracted from a prospectively maintained database identifying 227 RC/IC patients (pts) from 2015-2022. Complications were graded and classified by the Memorial Sloan Kettering Cancer Center system. Pts who developed GU infections were selected; uropathogens were analyzed for causative organism. Sensitivity patterns were used to create an RC-specific antibiogram.Beginning April 1, 2022, following discussion with antibiotic stewardship committee, low dose Levaquin or Bactrim was given POD#4 to RC pts with ileal conduits (RC/IC) until stent removal at 2 weeks. All GU infections were captured. Chi square and multivariable logistic regression analyses were performed to assess the association between antibiotic ppx and 30 and 90d readmissions due to GU infection. RESULTS: Enteric organisms were most likely to be identified as source pathogen. Levaquin covered 70.4% of organisms while Bactrim covered 50.0% (Figure 1).The 30d risk of any GU infections decreased following antibiotic ppx from 82/227 (36.1%) pre-ppx to 2/29 (6.9%) post-ppx (p<0.001, Table 1). Readmission due to GU infection was significantly reduced with 41/65 (63.1%) of pts readmitted with GU infection pre-ppx and only 1/5 (20%) post-ppx (p=0.05).After adjusting for covariates, receiving low dose antibiotic ppx was independently associated with a decreased risk of having a GU infection within 30 and 90d of RC/IC (Table 1). CONCLUSIONS: Targeted low dose daily antibiotic ppx is associated with a decrease in GU infections and 30d readmission due to GU infection. Overall readmission rates are not statistically different. This preliminary data is limited by sample size but is quite promising. Central to the success of this intervention is an institutional RC-specific antibiogram. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e351 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Randie E. White More articles by this author Joshua A. Linscott More articles by this author Erin Santos More articles by this author Connor Pelletier More articles by this author Stephen T. Ryan More articles by this author Matthew T. Hayn More articles by this author Jeffrey E. Howard More articles by this author Evelyn James More articles by this author Jesse D. Sammon More articles by this author Expand All Advertisement PDF downloadLoading ...