Relationship between intraoperative intestinal cultures and postoperative urinary infection in radical cystectomy with ileal diversion patients

Abstract

Introduction

Radical cystectomy (RC) is a preferred treatment for muscle-invasive bladder cancer (T2-T4) and certain non-muscle-invasive tumors. Post-cystectomy, urinary diversions often utilize intestinal segments, which are prone to complications, notably urinary tract infections (UTIs).

Objective

To estimate the association between intraoperative cultures of the isolated intestinal loop and urine cultures during UTI episodes in RC patients with urinary diversion. Additionally, to compare urinary cultures from catheters at discharge with UTI cultures and calculate UTI prevalence and readmission rates within three months postoperatively.

Materials and methods

This prospective, observational cohort study included patients who underwent RC with ileal segment diversion our center between April 2021 and January 2024. Intraoperative cultures were obtained by washing the isolated ileal loop, and urine cultures were taken during postoperative UTI episodes. Patients were followed for 90 days post-surgery, and new cultures were performed if UTI symptoms appeared.

Results

Among 118 cystectomies, 82 patients were included, with a mean age of 67.8 years. UTI prevalence within the first three months was 43.9%. The kappa concordance index for bacteria between intraoperative and UTI cultures was 0.033 (poor), and for cultures from discharge catheters and UTI episodes, it was 0.251 (fair). UTI readmission rate was 28.9%, with no significant predictors identified.

Conclusion

There is no significant association between germs in intraoperative intestinal cultures or discharge catheters and those in UTI cultures in RC patients with urinary diversion. The three-month UTI prevalence is 43.9%, with a 28.9% readmission rate. Continuous epidemiological surveillance is recommended for appropriate antibiotic therapy.