Presentation Authors: Hamza Beano*, Caitlin Hensel, Jiaxian He, William Worrilow, Rupali Bose, Jared Brown, Madolin Carol Haskin, Kris Gaston, Peter Clark, Stephen Riggs, Charlotte, NC
Introduction: We hypothesized that ureteral stent urine culture (UC) results may predict urinary tract infection(UTI)-related readmissions following robotic radical cystectomy with ileal conduit diversion (RCIC). Starting in 2015, we adopted a strict stent removal protocol to include stent urine culture (UC) and a single dose IV antibiotic given prior to removal targeted for postoperative day 4. We analyzed the results of this coordinated effort.
Methods: This is a single center analysis of a prospectively collected cystectomy dataset from 4/2015 to 1/2018. The patients were divided according to stent culture results into the positive cohort ( single or multiple organism with CFU>1,000) and negative cohort (no growth, contaminated results or organism/s growth with < 1,000 CFU). Measured outcomes were 90-day Urinary Adverse Events (UAE; UTI requiring inpatient or outpatient antibiotics within our institutional system or by outside report), overall-readmission rate and UTI-related readmission rates. Fisher's exact tests were used to compare rates and logistic regression was used to estimate odds ratios (OR).
Results: 202 patients underwent RCIC between 4/2015 and 1/2018. 146 patients had complete data and were included in the analysis. There were 70 patients in the positive group and 76 in the negative group. There was no statistically significant difference in the median age, gender, racial makeup, median Charlson Comorbidity Index (CCI), median ASA score, pathological stage or percentage of patients who underwent preoperative chemotherapy between both groups. The outcomes are summarized in the table. Multivariable logistic regression analysis concluded that a positive stent culture predicted higher UTI-related readmission rate (OR=4.19, 95%CI:1.16,15.11, p-value=0.029).
Conclusions: A positive stent culture was significantly associated with increased 90-day UTI-related readmission rate. There was no correlation with UAE or total readmission rates. Further analysis is warranted to study whether the organisms isolated with positive stent culture correlated with organisms isolated during UTI-related readmission episodes. Readmission incidence or severity could be mitigated by earlier, more precise antibiotic use and possibly use of prophylactic antibiotics per stent culture results.