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Vol. 45. Issue 4.
Pages 247-256 (May 2021)
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Vol. 45. Issue 4.
Pages 247-256 (May 2021)
Review article
Urinary tract infection as the main cause of admission in cystectomized patients
La infección del tracto urinario como causa principal de ingreso en pacientes cistectomizados
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P. Gayarre Abril
Corresponding author
paula17893@hotmail.com

Corresponding author.
, J. Subirá Ríos, L. Muñiz Suárez, C. Murillo Pérez, M. Ramírez Fabián, J.I. Hijazo Conejos, P. Medrano Llorente, J. García-Magariño Alonso, F.X. Elizalde Benito, G. Aleson Hornos, B. Blasco Beltrán, P. Carrera Lasfuentes
Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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Tables (7)
Table 1. Study variables in the group “post-cystectomy UTI at 90 days”.
Table 2. Preoperative ectasia and development of UTI at 90 days.
Table 3. Preoperative ectasia and development of UTI after removal of ureteral catheters.
Table 4. Study variables in the group of UTI after catheter removal.
Table 5. Postoperative ectasia and UTI onset at 90 days.
Table 6. Postoperative ectasia y onset of UTI after catheter removal.
Table 7. Detected germs and incidence according to study group.
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Abstract
Introduction and objectives

Radical cystectomy with urinary diversion associated with extended pelvic lymphadenectomy continues to be the treatment of choice in muscle invasive bladder cancer. Sixty-four percent of patients submitted to this procedure present postoperative complications, with urinary infection being responsible in 20–40% of cases. The aim of this project is to assess the rate of urinary infection as a cause of re-admission after cystectomy, and to identify protective and predisposing factors for urinary infection in our environment. Finally, we will evaluate the outcomes after the establishment of a prophylactic antibiotic protocol after removal of ureteral catheters.

Material and methods

Retrospective descriptive study of cystectomized patients in the Urology Service of the Hospital Clínico Universitario of Zaragoza, from January 2012 to December 2018. A urinary tract infection (UTI) prevention protocol after catheter removal is established for all patients since October 2017.

Results

UTI is responsible for 54.7% of readmissions, with 55.1% of these being due to UTI after removal of ureteral catheters. Of the patients who received with prophylaxis, 9.5% presented UTIs after withdrawal, compared to 10.6% in the group of patients without prophylaxis. The patient who is re-admitted for UTI after withdrawal has a mean catheter time of 24.3 ± 7.2 days, compared to 24.5 ± 7.4 days for patients in the group without UTI (P = .847).

Conclusions

The type of urinary diversion performed is not related to the rate of urinary infection. The regression model does not identify antibiotic prophylaxis, nor catheter time, as independent factors of UTI after catheter removal.

Keywords:
Radical cystectomy with urinary diversion
Urinary infection
Prophylactic antibiotic therapy
Catheter removal
Urine culture
Resumen
Introducción y objetivos

La cistectomía radical con derivación urinaria asociada a linfadenectomía pélvica ampliada continúa siendo el tratamiento de elección en el cáncer vesical musculoinvasivo. Un 64% de los pacientes presentan complicaciones postoperatorias, siendo la infección urinaria responsable en un 20–40% de los casos. El objetivo del presente proyecto es valorar la tasa de infección urinaria como causa de reingreso tras cistectomía, e identificar factores protectores y predisponentes de infección urinaria en nuestro medio. Por último, conocer los resultados obtenidos al aplicar el protocolo de profilaxis antibiótica tras la retirada de los catéteres ureterales.

Material y métodos

Estudio descriptivo retrospectivo de pacientes cistectomizados en el Servicio de Urología del Hospital Clínico Universitario desde enero de 2012 hasta diciembre de 2018. Desde octubre de 2017, de forma estandarizada, a todo paciente se le aplica un protocolo de prevención de infección del tracto urinario (ITU) tras la retirada de catéteres.

Resultados

La ITU es responsable del 54,7% de los reingresos, siendo un 55,1% de estos por causa de una ITU tras la retirada de los catéteres ureterales. El 9,5% de los pacientes con profilaxis presenta ITU tras la retirada, frente a un 10,6% en el grupo de pacientes sin profilaxis. El paciente que reingresa por ITU tras la retirada tiene un tiempo de catéteres medio de 24,3 ± 7,2 días, frente a los 24,5 ± 7,4 días en el grupo sin ITU (p = 0,847).

Conclusiones

El tipo de derivación urinaria empleada no guarda relación con la tasa de infección urinaria. El modelo de regresión no identifica la profilaxis antibiótica, ni tampoco el tiempo de catéteres, como factores independientes de ITU tras la retirada de los catéteres.

Palabras clave:
Cistectomía radical con derivación urinaria asociada
Infección urinaria
Antibioterapia profiláctica
Retirada de catéteres
Urocultivo

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