PURPOSE: Although perioperative antibiotic prophylaxis (ABP) prevents postsurgical infectious complications, national guidelines recommend cessation of antibiotics within 24 hours post-procedure. Extended antibiotic prophylaxis beyond 24 hours may contribute to hospital-acquired infections such as Clostridium difficile (C. diff) colitis. We sought to evaluate practice patterns for ABP in genitourinary cancer surgery and to assess the impact of ABP on hospital-acquired C. diff infections.
MATERIALS AND METHODS: We identified 59,184 patients undergoing radical prostatectomy (RP), 27,921 undergoing partial or radical nephrectomy (Nephx), and 5,425 patients undergoing radical cystectomy (RC) for prostate, kidney, and bladder cancers, respectively, from the Premier Perspectives Database from 2007-2012. We constructed hierarchical linear regression models to identify patient and hospital factors associated with extended ABP. We evaluated the association between extended ABP and C. diff infections for patients undergoing Nephx and RC with multivariable logistic regression.
RESULTS: Surgery-specific models demonstrated that hospital identity was associated with a substantial proportion of the variation in extended ABP (20-35% for RP, Nephx, and RC). Postoperative C. diff colitis occurred in 0.02% of RP patients, 0.23% of Nephx patients, and 1.7% of RC patients. On multivariable analysis, extended ABP was associated with higher odds of postoperative C. diff infection after Nephx (OR 3.79, 95% CI 2.46-5.84) and RC (OR 1.64, 95%CI 1.12-2.39).
CONCLUSIONS: Antibiotics may be overused after genitourinary cancer surgery and this overuse is associated with hospital-acquired C. diff colitis. Efforts are needed to encourage greater compliance with evidence-based approaches to postoperative care.
Written by:
Calvert JK, Holt SK, Mossanen M, James AC, Wright JL, Porter MP, Gore JL. Are you the author?
Department of Urology, University of Washington, Seattle, WA; VA Puget Sound Health Care System, Division of Urology, Seattle, WA.
Reference: J Urol. 2014 Mar 3. pii: S0022-5347(14)00354-1.
doi: 10.1016/j.juro.2014.02.096
PubMed Abstract
PMID: 24603103
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