Risk Factors and Microbial Distribution of Urinary Tract Infections Following Radical Cystectomy

Objective To evaluate clinicopathologic features associated with the risk of urinary tract infection (UTI) after radical cystectomy (RC), and determine the underlying organisms responsible for these events. Materials and Methods We reviewed 1248 patients treated with RC for bladder cancer from 2000 to 2010 at Mayo Clinic. UTIs diagnosed within 90 days of surgery were recorded. Multivariable logistic regression analysis was performed to evaluate the association of clinicopathologic features with postoperative UTI. Results UTI was diagnosed in 129 (10.3%) patients within 90 days of RC. Median time to UTI was 22.5 days (interquartile range 14,42). On multivariable analysis, factors associated with a significantly increased UTI risk were diabetes (odds ratio [OR] 2.27; P < .001), receipt of a perioperative blood transfusion (OR 1.58; P = .03), continent urinary diversion (OR 2.17;P < .001), and development of a urine leak (OR 3.42;P < .001). Culture-specific infection data were available for 88 of the patients, with a total of 113 UTIs diagnosed among this cohort. Of these, 36.8% of UTIs were polymicrobial. Drug-resistant Staphylococcus aureus and Enterococcus were isolated in 45.0% and 12.8% of infections, respectively. Fungal elements were present in 27 (23.9%) cultures, and were the sole organism in 15 (13.3%). No significant differences in microbial distribution or timing of infections were detected between patients who underwent conduit vs continent diversion. Conclusion We found that diabetes, perioperative blood transfusion, continent diversion, and urine leak were associated with UTI risk following RC. Multiple organisms, drug resistance, and fungal elements were commonly identified, supporting the use of initial broad-spectrum coverage, including consideration of antifungal therapy, upon diagnosis of UTI after RC.