Presentation Authors: Craig Labbate*, Chicago, IL, Kristine Kuchta, Evanston, IL, Brittany Adamic, Joshua Aizen, Ryan Werntz, Chicago, IL, Norm Smith, Evanston, IL
Introduction: Radical cystectomy (RC) with urinary diversion has a high rate of perioperative surgical site infection leading to significant morbidity. In the evaluation of bladder cancer, patients undergo frequent urinary instrumentation and exposure to oral prophylactic antibiotics which may alter the microbiome. Using a national sample database, we aimed to determine exposure rates to outpatient antibiotics prior to radical cystectomy and their correlation with post-operative infections.
Methods: 2248 patients in the SEER-Medicare database underwent radical cystectomy between 2008 and 2014 and had requisite prescription claims information. An outpatient prescription for any antibiotic within 30 days prior to cystectomy was considered exposure. Postoperative infection claims, readmissions, and deaths were tabulated within 30 days of operation.
Results: Within the cohort, 1,149 (51.1%) patients were identified to have been prescribed outpatient antibiotics before cystectomy. 545 (31.9%) of the prescriptions were for a fluoroquinolone. Only 94 (8.2%) of these patients were diagnosed with a preoperative UTI. Patients receiving outpatient antibiotics were more likely to be female (p < .001) and have a higher Elixhauser comorbidity index (p < .0001). Those who received antibiotics before RC were more likely to be diagnosed postoperatively with any infection (56% vs 51% p < 0.01), pneumonia (13% vs 9%, p < 0.01), and UTI (36% vs 31% p < 0.01). There was no difference in Clostridium difficile infection, sepsis or mortality within 30 days. Multivariate logistic regression controlling for other identified risk factors (including preoperative UTI and comorbidity index) confirmed that receiving a preoperative outpatient antibiotic is in an independent risk factor for postoperative infection (HR 1.19, p = 0.05) and readmission (HR 1.24, p=0.03).
Conclusions: Outpatient antibiotic use before RC for bladder cancer is associated with increased risk of postoperative infection and readmission within 30 days. Judicious antibiotic use in the evaluation of bladder cancer should be considered to decrease morbidity associated with RC.