For a study, researchers sought to assess antibiotic exposure rates before radical cystectomy and whether there is an association with post-operative infections.
In the 2016 SEER-Medicare linkage, 2,248 patients with complete prescription information who underwent radical cystectomy between 2008 and 2014 were found. Exposure was defined as an outpatient prescription for an antibiotic within 30 days of the cystectomy. The antibiotic class and combinations were documented. Within 30 days following cystectomy, infection diagnoses and readmissions were recorded.
Prior to cystectomy, 51% of patients (n=1,149) were given an outpatient antibiotic. Patients getting antibiotics were more likely to be female (31% vs. 25%, P<.01) and to have been diagnosed with an infection (17% vs. 11%, P<.01). Antibiotic bowel prophylaxis was recommended to 42% of antibiotic-treated individuals. The exposure group had a higher incidence of any infection (56% vs. 51% P<.01) and UTI (36% vs. 31% P<.01) postoperatively. The exposure cohort had a greater rate of all-cause readmission within 30 days (26% vs. 22%, P=.02). Outpatient preoperative antibiotics were found to be an independent risk factor for any infection (HR 1.19, P<.05) and readmission (hazards ratio 1.24, P=.03) in the 30 days following radical cystectomy using multivariable logistic regression.
Outpatient antibiotic usage is prevalent before radical cystectomy and may be related to an increased risk of postoperative infection and readmission. Antibiotic usage before radical cystectomy should be investigated as a controllable factor to reduce post-operative morbidity.