MP26-07 URETERAL STENT URINE CULTURE FOLLOWING RADICAL CYSTECTOMY WITH ILEAL CONDUIT DIVERSION PREDICTS UTI-RELATED READMISSION RATES

摘要

You have accessJournal of UrologyBladder Cancer: Invasive I (MP26)1 Apr 2019MP26-07 URETERAL STENT URINE CULTURE FOLLOWING RADICAL CYSTECTOMY WITH ILEAL CONDUIT DIVERSION PREDICTS UTI-RELATED READMISSION RATES Hamza Beano*, Caitlin Hensel, Jiaxian He, William Worrilow, Rupali Bose, Jared Brown, Madolin Carol Haskin, Kris Gaston, Peter Clark, and Stephen Riggs Hamza Beano*Hamza Beano* More articles by this author , Caitlin HenselCaitlin Hensel More articles by this author , Jiaxian HeJiaxian He More articles by this author , William WorrilowWilliam Worrilow More articles by this author , Rupali BoseRupali Bose More articles by this author , Jared BrownJared Brown More articles by this author , Madolin Carol HaskinMadolin Carol Haskin More articles by this author , Kris GastonKris Gaston More articles by this author , Peter ClarkPeter Clark More articles by this author , and Stephen RiggsStephen Riggs More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000555672.13613.73AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: We hypothesized that ureteral stent urine culture (UC) results may predict urinary tract infection(UTI)-related readmissions following robotic radical cystectomy with ileal conduit diversion (RCIC). Starting in 2015, we adopted a strict stent removal protocol to include stent urine culture (UC) and a single dose IV antibiotic given prior to removal targeted for postoperative day 4. We analyzed the results of this coordinated effort. METHODS: This is a single center analysis of a prospectively collected cystectomy dataset from 4/2015 to 1/2018. The patients were divided according to stent culture results into the positive cohort ( single or multiple organism with CFU>1,000) and negative cohort (no growth, contaminated results or organism/s growth with <1,000 CFU). Measured outcomes were 90-day Urinary Adverse Events (UAE; UTI requiring inpatient or outpatient antibiotics within our institutional system or by outside report), overall-readmission rate and UTI-related readmission rates. Fisher’s exact tests were used to compare rates and logistic regression was used to estimate odds ratios (OR). RESULTS: 202 patients underwent RCIC between 4/2015 and 1/2018. 146 patients had complete data and were included in the analysis. There were 70 patients in the positive group and 76 in the negative group. There was no statistically significant difference in the median age, gender, racial makeup, median Charlson Comorbidity Index (CCI), median ASA score, pathological stage or percentage of patients who underwent preoperative chemotherapy between both groups. The outcomes are summarized in the table. Multivariable logistic regression analysis concluded that a positive stent culture predicted higher UTI-related readmission rate (OR=4.19, 95%CI:1.16,15.11, p-value=0.029). CONCLUSIONS: A positive stent culture was significantly associated with increased 90-day UTI-related readmission rate. There was no correlation with UAE or total readmission rates. Further analysis is warranted to study whether the organisms isolated with positive stent culture correlated with organisms isolated during UTI-related readmission episodes. Readmission incidence or severity could be mitigated by earlier, more precise antibiotic use and possibly use of prophylactic antibiotics per stent culture results. Source of Funding: none Charlotte, NC© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e355-e355 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hamza Beano* More articles by this author Caitlin Hensel More articles by this author Jiaxian He More articles by this author William Worrilow More articles by this author Rupali Bose More artic