"Cystectomy .. What Bugs You?" : Creation of an Institutional Antibiogram
Erin Santos, PA, MPH1, Joshua Linscott, MD, PhD2, Jesse D. Sammon, DO3.
1Maine Medical Partners Urology, Portland, ME, USA, 2Maine Medical Center - Division of Urology, Portland, ME, USA, 3Maine Medical Center - Division of Urology & Center for Outcomes Research and Evaluation, Portland, ME, USA.
TitleCystectomy.. What Bugs You?Creation of Institutional AntibiogramAuthors:Erin Santos, PA-C , Joshua Linscott, MD, PhD, Jesse D Sammon, DOBackground:Radical cystectomy, the preferred treatment for non metastatic muscle invasive bladder cancer, isassociated with high rates of post operative morbidity and mortality. Studies estimate up to a 60% 90 daycomplication rate. Most research studies show infections account for 30-40% of these complications. Toimprove morbidity and readmission rates following radical cystectomy, a post cystectomy dischargepathway was created. We set out to create an institution specific antibiogram to identify most commoncausative organisms to target as a way to specifically decrease genitourinary infection relatedcomplications.Methods:We assessed 216 patients who underwent cystectomy from 2015 to 2021 at Maine Medical Center. Of the170 patients who had any post op complications, 82 (37.9%) patients developed an infection of thegenitourinary tract and 32 of those resulted in readmission. Of the 84 total readmissions, 38% werereadmitted with a uropathogen as suspected source. We extracted uropathogens from our patient data setand analyzed the 84 causative organisms and sensitivity patterns, where available, to create anantibiogram specific to our institution.Results:The most common causative organisms of urinary tract infection following radical cystectomy at ourinstitution were Enterococcus faecalis (n=14), Escherichia coli (n=12) and Klebsiella spp (n=12). Thiswas followed by Enterobacter spp (n=8), Pseudomonas aeruginosa (n=8), Staphylococcus aureus (n=8),Staphylococcus, coagulase negative spp (n=6), Serratia Marcecens (n=4), Yeast (n=4) Citrobacter spp(n=3), Enterococcus faecium (n=2), Proteus mirabilis (n=1), Streptococcus spp (n=1) and unidentified(n=1). Sensitivities to above organisms do vary but analysis of trends do reveal oral antibiotics that can beused to target the most common organisms. The organisms that are most likely to be pathogenic are thebacterial enteric pathogens. When focusing on those organisms, we find 70.3% sensitivity to levofloxacinand 50% sensitivity to trimethoprim/sulfamethoxazole. See antibiogram attachedConclusionsThis institutional antibiogram will help inform implementation of a post-operative antibiotic protocolaimed at decreasing readmission rates. For the post cystectomy discharge pathway the above analysiswarrants use of a low dose levofloxacin (250mg daily) as first line agent to prevent infection until theureteral stent is removed. Second line use of trimethoprim / sulfamethoxazole 800/160mg daily can beutilized where there is allergy or contraindications to the quinolone class (i.e. history of aortic aneurysmor tendinopathy). There are concerns about antibiotic resistance in this population. However, it isworthwhile to utilize a short course of commonly prescribed antibiotics to reduce infection that hashistorically occurred in over a third of cystectomy patients.
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