OBJECTIVES: Radical cystectomy (RC) with urinary diversion has a significant risk of @entity281 . In an effort to decrease the rate of @entity166 complications, we instituted a broader, culture-based preoperative antimicrobial regimen, including fungal coverage, and studied its effect on @entity166 complications after RC. MATERIALS AND METHODS: In May 2013, antimicrobial prophylaxis for RC was changed at our institution after review of previous positive cultures. @entity869 - @entity5899 3g, @entity801 4mg/kg, and @entity2380 400mg replaced @entity3398 . @entity1 undergoing RC from May 2011 to May 2014 were included. Before and after implementation of the new regimen, 30-day @entity166 complications (positive blood culture, @entity293 , wound @entity281 , abscess, and @entity55 ) and adverse events ( @entity2718 , readmission, and mortality) were compared. Multivariate logistic regression was used to identify independent risk factors for @entity281 while controlling for covariates. RESULTS: In total, 386 @entity1 were studied (258 before the change and 128 after). The overall @entity281 rate decreased with the new regimen (41% vs. 30%, P = 0.043) with improvements in wound (14% vs. 6%, P = 0.025) and fungal (10% vs. 3%, P = 0.021) @entity281 . Median length of stay decreased from 8 (interquartile range [IQR]: 7-12) to 7 (IQR: 7-10) days (P = 0.008). On multivariate analysis, the new regimen decreased the risk of @entity281 (odds ratio [OR] = 0.58, 95% CI [0.35-0.99], P = 0.044) whereas body mass index, operating room time, smoking, and total parenteral nutrition increased the risk (all P< 0.05). CONCLUSIONS: Risk factors for @entity281 after RC include body mass index, operating room time, smoking, and total parenteral nutrition use. Changing from @entity3398 to broader, culture-directed antimicrobial prophylaxis, based on institutional data to include antifungal coverage, @entity86 .

The effect of broader, directed antimicrobial prophylaxis including fungal coverage on perioperative XXXX complications after radical cystectomy.

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients'] @entity801 :: ('MESH:D005839', 'Chemical') :: ['gentamicin'] @entity2380 :: ('MESH:D015725', 'Chemical') :: ['fluconazole'] @entity55 :: ('MESH:D011014', 'Disease') :: ['pneumonia'] @entity281 :: ('MESH:D007239', 'Disease') :: ['infection', 'infections'] @entity86 :: ('MESH:D019106', 'Disease') :: ['decreased postoperative infections'] @entity293 :: ('MESH:D014552', 'Disease') :: ['urinary tract infection'] @entity869 :: ('MESH:D000667', 'Chemical') :: ['Ampicillin'] @entity5899 :: ('MESH:D013407', 'Chemical') :: ['sulbactam'] @entity166 :: ('MESH:D003141', 'Disease') :: ['infectious'] @entity3398 :: ('MESH:D002440', 'Chemical') :: ['cefoxitin'] @entity2718 :: ('1496', 'Species') :: ['Clostridium difficile']
@entity166 :: (MESH:D003141,Disease) :: ['infectious']
