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

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State: Public
Version: Final published version
License: CC BY 4.0
Serval ID
serval:BIB_CF5E10DCC184
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Institution
Title
Association Between Antibiotic Prophylaxis Before Cystectomy or Stent Removal and Infection Complications: A Systematic Review.
Journal
European urology focus
Author(s)
Antonelli L., Sebro K., Lahmar A., Black P.C., Ghodoussipour S., Hamilton-Reeves J.M., Shah J., Bente Thoft J., Lerner S.P., Llorente C., Lucca I., Preston M.A., Psutka S.P., Sfakianos J.P., Vahr Lauridsen S., Williams S.B., Catto J., Djaladat H., Kassouf W., Loftus K., Daneshmand S., Fankhauser C.D.
Working group(s)
Enhanced Recovery After Surgery ERAS Cystectomy Committee
ISSN
2405-4569 (Electronic)
ISSN-L
2405-4569
Publication state
Published
Issued date
07/2023
Peer-reviewed
Oui
Volume
9
Number
4
Pages
631-636
Language
english
Notes
Publication types: Systematic Review ; Journal Article ; Review
Publication Status: ppublish
Abstract
Patients undergoing radical cystectomy frequently suffer from infectious complications, including urinary tract infections (UTIs) and surgical site infections (SSIs) leading to emergency department visits, hospital readmission, and added cost.
To summarize the literature regarding perioperative antibiotic prophylaxis, ureteric stent usage, and prevalence of infectious complications after cystectomy.
A systematic review of PubMed/Medline, EMBASE, Cochrane Library, and reference lists was conducted.
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 prophylactic 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%).
We confirmed a high proportion of infectious complications after cystectomy, 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.
In this review, we observed wide variability in the use of antibiotics before or after surgical removal of the bladder.
Keywords
Humans, Antibiotic Prophylaxis/adverse effects, Cystectomy/adverse effects, Prospective Studies, Anti-Bacterial Agents/therapeutic use, Surgical Wound Infection/epidemiology, Surgical Wound Infection/prevention & control, Urinary Tract Infections/epidemiology, Urinary Tract Infections/prevention & control, Urinary Tract Infections/etiology, Stents/adverse effects, Antibiotic prophylaxis, Cystectomy, Infection, Postoperative complications, Sepsis
Pubmed
Web of science
Open Access
Yes
Create date
03/03/2023 14:49
Last modification date
13/02/2024 8:37
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