The Association Between Duration of Antibiotics and Infectious Complications Following Radical Cystectomy: Analysis of the 2019-2021 NSQIP Database

Rachel Passarelli; John Pfail; Alain Kaldany; Kevin Chua; Benjamin Lichtbroun; Hiren V Patel; Arnav Srivastava; David Golombos; Thomas L Jang; Vignesh T Packiam; Saum Ghodoussipour

doi:10.1016/j.urology.2024.04.006

The Association Between Duration of Antibiotics and Infectious Complications Following Radical Cystectomy: Analysis of the 2019-2021 NSQIP Database

Urology. 2024 Apr 20:S0090-4295(24)00263-2. doi: 10.1016/j.urology.2024.04.006. Online ahead of print.

Authors

Affiliations

¹ Division of Urology, Rutgers Robert Wood Johnson, New Brunswick, NJ. Electronic address: rp1169@rwjms.rutgers.edu.
² Division of Urology, Rutgers Robert Wood Johnson, New Brunswick, NJ.
³ Department of Urology, University of California at San Francisco, San Francisco, CA.
⁴ Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor MI.
⁵ Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.

PMID: 38648953
DOI: 10.1016/j.urology.2024.04.006

Abstract

Objectives: To identify the impact of the duration of peri-operative antibiotics on infectious complications following radical cystectomy.

Methods: The National Surgical Quality Improvement Project (NSQIP) targeted database was queried for patients undergoing radical cystectomy from 2019-2021. Baseline patient characteristics were collected. Antibiotic duration was classified as <24 hours (short), 24-72 hours (intermediate) or >72 hours (long). Infectious complication data was collected including surgical site infection (SSI), urinary tract infection (UTI), organ space infection, pneumonia, sepsis, and clostridium difficile infection up to 30 days after surgery. Univariate and multivariable analyses were performed to compare duration of antibiotic therapy to infectious outcomes.

Results: Of the 4,363 patients who underwent radical cystectomy, 3,250(74%), 827(19%) and 286(6.6%) received short, intermediate, and long duration of peri-operative antibiotics respectively. Infectious complication occurred in 954(22%) patients, including 227(5.2%) SSI, 280(6.4%) UTI, 268(6.1%) organ space infection, 87(2%) pneumonia, and 378(8.7%) sepsis. Clostridium difficile infection occurred in 89(2%) patients. On multivariable analysis, there was no significant difference in overall infectious complication rates with long duration antibiotics. However, intermediate duration of antibiotics in open surgery was associated with a decreased risk of SSI (OR 0.58; 95%CI 0.37-0.91) compared to those treated with short term antibiotics.

Conclusions: Despite guideline recommendations, 26% of patients in this database received >24 hours of peri-operative antibiotics without decreased risk of overall infectious complication. An intermediate course of antibiotics decreased risk of SSI in open surgery compared to the guideline recommend <24-hour course. Greater education regarding antibiotic stewardship and further studies investigating infectious complications are warranted.