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MP23-16: Targeted antibiotic prophylaxis can prevent febrile urinary tract infection after removal of ureteral stents in radical cystectomy patients with intestinal urinary diversion.

Saturday, May 13
7:00 AM - 9:00 AM
Location: BCEC: Room 151

Presentation Authors: Yoshitsugu Nasu*, Tadashi Murata, Morito Sugimoto, Atsushi Takamoto, Okayama, Japan, Noriaki Ono, Kochi, Japan

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).
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.


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.

Source Of Funding: none

Yoshitsugu Nasu

CURRICULUM VITAE

YOSHITSUGU NASU, M.D.,Ph.D.


PRESENT ADDRESS :
OFFICE : Department of Urology
Okayama Rosai Hospital
1-10-25,Chikkou Midori-Machi, Okayama 7028055, Japan
Tel; +81-86-262-0131
Fax; +81-86-262-3391
Email; khscuro@hotmail.com
HOME : 11-6-901, Daiku-omote-machi, Okayama 7000912, Japan
Tel; +81-86-238-3418

PRESENT POSITION :
Head, Department of Urology
Okayama Rosai Hospital

PERSONAL DATA :
Date of birth ; February 27, 1960
Nationality ; Japan
Marital status ; Married (Spouse’s name: Kazumi Nasu)

EDUCATION:
1984 M.D., Okayama University Medical School, Japan
1988 Ph.D., Post-graduate School of Okayama University

TRAINING :
1988-2001 Okayama University Hospital
Kure Kyosai Hospital
Juzen General Hospital

MEMBERSHIPS :
Japanese Urological Association
AUA
EAU
Societe Internationale d’Urologie
Japanese Society of Clinical Oncology
Japanese Society of Endourology and ESWL
Japan Society of Transplantation
Japanese Society of Pediatric Surgeons
Japanese Society for Pediatric Nephrology
Japanese Association for Infectious Disease
Japanese Society for Bacteriology
Japanese Society of Chemotherapy

Presentation(s):

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MP23-16: Targeted antibiotic prophylaxis can prevent febrile urinary tract infection after removal of ureteral stents in radical cystectomy patients with intestinal urinary diversion.



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