BERKELEY, CA (UroToday.com) - Radical cystectomy (RC), followed by urinary diversion or reconstruction, is a standard treatment for patients with muscle-invasive bladder cancer. Unfortunately, the frequency of postoperative complications, including postoperative infection, is relatively high compared to other types of urologic surgery.[1] Surgical site infection (SSI) is one of the major complications in RC. However, there have been few studies about the significance of anaerobic bacteria in SSI or postoperative infection after RC. The rate of anaerobic bacteria isolated from patients who had SSI in the lower intestinal tract surgery, including the colon and rectum was reported to be 5.5%.[2] If anaerobic bacteria play a role in postoperative infection after RC, additional manipulations (e.g., prompt abscess draining) or treatments (e.g., administering an antimicrobial for aerobic bacteria) are needed for patients who might develop such infections.
Our study revealed the possible development of a nonnegligible number of postoperative anaerobic bacterial infections in patients who underwent RC. In this study, a second-generation cephalosporin antimicrobial agent was commonly administered as antimicrobial prophylaxis for patients in whom anaerobic bacteria were isolated. A recent study suggested that antimicrobial prophylaxis for RC must cover both anaerobic and aerobic bacteria.[3]
Although the incidence of infection caused by anaerobic bacteria was not as high as found in colon surgery, it may not be negligible in RC perioperative infection. To properly manage postoperative infection in patients who undergo RC, we should be aware of the possible pathogens, including anaerobic bacteria, as causative agents for postoperative infection.
References:
- Ichihara K, Masumori N, Muto M, Fukuta F, Hirobe M, Kitamura H, Tsukamoto T. Retrospective analysis of early postoperative complications of radical cystectomy and urinary diversion performed during a 17-year period. Hinyokika Kiyo 2010; 56: 605-11. (Japanese)
- Elena M, Antonio R, Teresa AE, Josep V, Jose SP, Vicente P, Angel A. Microbiology of surgery site infections in abdominal tract surgery patients. CIR ESP 2011; 89: 606-12
- Tanaka K, Arakawa S, Miura T, Shigemura K, NakanoY, Takahashi S, Tsukamoto T, Matsumoto T, Fujisawa M. Analysis of isolated bacteria and short-term antimicrobial prophylaxis with tazobactam-piperacillin (1:4 ratio) for prevention of postoperative infections after radical cystectomy. J Infect Chemother 2012; 18: 175-9
Written by:
Yoshiki Hiyama, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Department of Urology,
Sapporo Medical University
School of Medicine
Sapporo, Japan
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