Risk for Clostridium difficile infection after radical cystectomy for bladder cancer: Analysis of a contemporary series

Nick W. Liu, Kashyap Shatagopam, M. Francesca Monn, Hristos Kaimakliotis, K. Clinton Cary, Ronald S. Boris, Matthew J. Mellon, Timothy Masterson, Richard Foster, Thomas Gardner, Richard Bihrle, Michael House, Michael Koch

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11 Citations (Scopus)

Abstract

Introduction: This study seeks to evaluate the incidence and associated risk factors of Clostridium difficile infection (CDI) in patients undergoing radical cystectomy (RC) for bladder cancer. Methods: We retrospectively reviewed a single institution's bladder cancer database including all patients who underwent RC between 2010 and 2013. CDI was diagnosed by detection of Clostridium difficile toxin B gene using polymerase chain reaction-based stool assay in patients with clinically significant diarrhea within 90 days of the index operation. A multivariable logistic regression model was used to identify demographics and perioperative factors associated with developing CDI. Results: Of the 552 patients who underwent RC, postoperative CDI occurred in 49 patients (8.8%) with a median time to diagnosis after RC of 7 days (interquartile range: 5-19). Of the 122 readmissions for postoperative complications, 10% (n = 12) were related to CDI; 2 patients died of sepsis directly related to severe CDI. On multivariate logistic regression, the use of chronic antacid therapy (odds ratio = 1.9, 95% CI: 1.02-3.68, P = 0.04) and antibiotic exposure greater than 7 days (odds ratio = 2.2, 95% CI: 1.11-4.44, P = 0.02) were independently associated with developing CDI. The use of preoperative antibiotics for positive findings on urine culture within 30 days before surgery was not statistically significantly associated with development of CDI (P = 0.06). Conclusions: The development of CDI occurs in 8.8% of patients undergoing RC. Our study demonstrates that use of chronic antacid therapy and long duration of antimicrobial exposure are associated with development of CDI. Efforts focusing on minimizing antibiotic exposure in patients undergoing RC are needed, and perioperative antimicrobial prophylaxis guidelines should be followed.

Original languageEnglish (US)
Pages (from-to)503.e17-503.e22
JournalUrologic Oncology: Seminars and Original Investigations
Volume33
Issue number12
DOIs
StatePublished - Dec 1 2015

Fingerprint

Clostridium Infections
Clostridium difficile
Cystectomy
Urinary Bladder Neoplasms
Antacids
Logistic Models
Anti-Bacterial Agents
Odds Ratio
Ambulatory Surgical Procedures
Diarrhea
Sepsis
Demography
Urine
Databases
Guidelines

Keywords

  • Bladder cancer
  • Clostridium difficile
  • Infection
  • Radical cystectomy
  • Urinary diversions

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

@article{2221a100dc8848aaa2a177954d0d2f46,
title = "Risk for Clostridium difficile infection after radical cystectomy for bladder cancer: Analysis of a contemporary series",
abstract = "Introduction: This study seeks to evaluate the incidence and associated risk factors of Clostridium difficile infection (CDI) in patients undergoing radical cystectomy (RC) for bladder cancer. Methods: We retrospectively reviewed a single institution's bladder cancer database including all patients who underwent RC between 2010 and 2013. CDI was diagnosed by detection of Clostridium difficile toxin B gene using polymerase chain reaction-based stool assay in patients with clinically significant diarrhea within 90 days of the index operation. A multivariable logistic regression model was used to identify demographics and perioperative factors associated with developing CDI. Results: Of the 552 patients who underwent RC, postoperative CDI occurred in 49 patients (8.8{\%}) with a median time to diagnosis after RC of 7 days (interquartile range: 5-19). Of the 122 readmissions for postoperative complications, 10{\%} (n = 12) were related to CDI; 2 patients died of sepsis directly related to severe CDI. On multivariate logistic regression, the use of chronic antacid therapy (odds ratio = 1.9, 95{\%} CI: 1.02-3.68, P = 0.04) and antibiotic exposure greater than 7 days (odds ratio = 2.2, 95{\%} CI: 1.11-4.44, P = 0.02) were independently associated with developing CDI. The use of preoperative antibiotics for positive findings on urine culture within 30 days before surgery was not statistically significantly associated with development of CDI (P = 0.06). Conclusions: The development of CDI occurs in 8.8{\%} of patients undergoing RC. Our study demonstrates that use of chronic antacid therapy and long duration of antimicrobial exposure are associated with development of CDI. Efforts focusing on minimizing antibiotic exposure in patients undergoing RC are needed, and perioperative antimicrobial prophylaxis guidelines should be followed.",
keywords = "Bladder cancer, Clostridium difficile, Infection, Radical cystectomy, Urinary diversions",
author = "Liu, {Nick W.} and Kashyap Shatagopam and Monn, {M. Francesca} and Hristos Kaimakliotis and Cary, {K. Clinton} and Boris, {Ronald S.} and Mellon, {Matthew J.} and Timothy Masterson and Richard Foster and Thomas Gardner and Richard Bihrle and Michael House and Michael Koch",
year = "2015",
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doi = "10.1016/j.urolonc.2015.07.007",
language = "English (US)",
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pages = "503.e17--503.e22",
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issn = "1078-1439",
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T1 - Risk for Clostridium difficile infection after radical cystectomy for bladder cancer

T2 - Analysis of a contemporary series

AU - Liu, Nick W.

AU - Shatagopam, Kashyap

AU - Monn, M. Francesca

AU - Kaimakliotis, Hristos

AU - Cary, K. Clinton

AU - Boris, Ronald S.

AU - Mellon, Matthew J.

AU - Masterson, Timothy

AU - Foster, Richard

AU - Gardner, Thomas

AU - Bihrle, Richard

AU - House, Michael

AU - Koch, Michael

PY - 2015/12/1

Y1 - 2015/12/1

N2 - Introduction: This study seeks to evaluate the incidence and associated risk factors of Clostridium difficile infection (CDI) in patients undergoing radical cystectomy (RC) for bladder cancer. Methods: We retrospectively reviewed a single institution's bladder cancer database including all patients who underwent RC between 2010 and 2013. CDI was diagnosed by detection of Clostridium difficile toxin B gene using polymerase chain reaction-based stool assay in patients with clinically significant diarrhea within 90 days of the index operation. A multivariable logistic regression model was used to identify demographics and perioperative factors associated with developing CDI. Results: Of the 552 patients who underwent RC, postoperative CDI occurred in 49 patients (8.8%) with a median time to diagnosis after RC of 7 days (interquartile range: 5-19). Of the 122 readmissions for postoperative complications, 10% (n = 12) were related to CDI; 2 patients died of sepsis directly related to severe CDI. On multivariate logistic regression, the use of chronic antacid therapy (odds ratio = 1.9, 95% CI: 1.02-3.68, P = 0.04) and antibiotic exposure greater than 7 days (odds ratio = 2.2, 95% CI: 1.11-4.44, P = 0.02) were independently associated with developing CDI. The use of preoperative antibiotics for positive findings on urine culture within 30 days before surgery was not statistically significantly associated with development of CDI (P = 0.06). Conclusions: The development of CDI occurs in 8.8% of patients undergoing RC. Our study demonstrates that use of chronic antacid therapy and long duration of antimicrobial exposure are associated with development of CDI. Efforts focusing on minimizing antibiotic exposure in patients undergoing RC are needed, and perioperative antimicrobial prophylaxis guidelines should be followed.

AB - Introduction: This study seeks to evaluate the incidence and associated risk factors of Clostridium difficile infection (CDI) in patients undergoing radical cystectomy (RC) for bladder cancer. Methods: We retrospectively reviewed a single institution's bladder cancer database including all patients who underwent RC between 2010 and 2013. CDI was diagnosed by detection of Clostridium difficile toxin B gene using polymerase chain reaction-based stool assay in patients with clinically significant diarrhea within 90 days of the index operation. A multivariable logistic regression model was used to identify demographics and perioperative factors associated with developing CDI. Results: Of the 552 patients who underwent RC, postoperative CDI occurred in 49 patients (8.8%) with a median time to diagnosis after RC of 7 days (interquartile range: 5-19). Of the 122 readmissions for postoperative complications, 10% (n = 12) were related to CDI; 2 patients died of sepsis directly related to severe CDI. On multivariate logistic regression, the use of chronic antacid therapy (odds ratio = 1.9, 95% CI: 1.02-3.68, P = 0.04) and antibiotic exposure greater than 7 days (odds ratio = 2.2, 95% CI: 1.11-4.44, P = 0.02) were independently associated with developing CDI. The use of preoperative antibiotics for positive findings on urine culture within 30 days before surgery was not statistically significantly associated with development of CDI (P = 0.06). Conclusions: The development of CDI occurs in 8.8% of patients undergoing RC. Our study demonstrates that use of chronic antacid therapy and long duration of antimicrobial exposure are associated with development of CDI. Efforts focusing on minimizing antibiotic exposure in patients undergoing RC are needed, and perioperative antimicrobial prophylaxis guidelines should be followed.

KW - Bladder cancer

KW - Clostridium difficile

KW - Infection

KW - Radical cystectomy

KW - Urinary diversions

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