MP65-14 INCIDENCE AND RISK FOR CLOSTRIDIUM DIFFICILE INFECTIOUS COLITIS IN PATIENTS UNDERGOING RADICAL CYSTECTOMY FOR BLADDER CANCER (2015)

You have accessJournal of UrologyBladder Cancer: Invasive III1 Apr 2015MP65-14 INCIDENCE AND RISK FOR CLOSTRIDIUM DIFFICILE INFECTIOUS COLITIS IN PATIENTS UNDERGOING RADICAL CYSTECTOMY FOR BLADDER CANCER Kashyap Shatagopam, Nick Liu, M. Francesca Monn, Clinton Bahler, Hristos Kaimakliotis, K. Clint Cary, Ronald Boris, Matthew Mellon, Timothy Masterson, Richard Bihrle, Richard Foster, Thomas Gardner, Michael House, and Michael Koch Kashyap ShatagopamKashyap Shatagopam More articles by this author , Nick LiuNick Liu More articles by this author , M. Francesca MonnM. Francesca Monn More articles by this author , Clinton BahlerClinton Bahler More articles by this author , Hristos KaimakliotisHristos Kaimakliotis More articles by this author , K. Clint CaryK. Clint Cary More articles by this author , Ronald BorisRonald Boris More articles by this author , Matthew MellonMatthew Mellon More articles by this author , Timothy MastersonTimothy Masterson More articles by this author , Richard BihrleRichard Bihrle More articles by this author , Richard FosterRichard Foster More articles by this author , Thomas GardnerThomas Gardner More articles by this author , Michael HouseMichael House More articles by this author , and Michael KochMichael Koch More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2304AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES This study seeks to evaluate the incidence and associated risk factors for Clostridium difficile infectious colitis (CDI) in patients undergoing radical cystectomy for bladder cancer. METHODS We retrospectively reviewed an institutional database of 554 patients who underwent radical cystectomy between 2010 and 2013 to identify patients who developed CDI. CDI was detected by stool toxin assay in patients with clinically significant diarrhea within 90 days of the index operation. Stepwise logistic regression was used to identify pre- and perioperative factors associated with developing CDI. The final multivariable logistic regression model for factors associated with CDI was composed of variables found to have p<0.2 on forward and backward stepwise logistic regression. RESULTS Postoperative CDI occurred in 49 patients (8.8%) with a median time to diagnosis after cystectomy of 7 days (3 – 51). Of the 122 readmissions for post-cystectomy complications, 9.0% (n=11) were related to CDI. Two patients died from sepsis related to severe CDI. The incidence of CDI by year of cystectomy was 9 (6%) in 2010, 7 (5%) in 2011, 12 (9%) in 2012 and 21 (15%) in 2013 (ptrend=0.004). On multivariate logistic regression, preoperative use of histamine-2 antagonists or proton-pump inhibitors (OR: 2.05, 95% CI 1.07 – 3.93, p=0.03), postoperative acute renal failure (OR: 3.0, 95% CI: 1.23 – 7.49, p=0.016), and cumulative intravenous antibiotic use greater than 6 doses during hospitalization (OR: 15.63, 95% CI: 1.40 – 174.46, p=0.026) were independently associated with developing CDI. The use of preoperative antibiotics within 30 days of surgery was not associated with development of CDI (p=0.46). While the incidence of CDI was higher among patients with Indiana pouch compared to ileal conduit and orthotopic neobladder (11.2% vs. 10% and 3.3%, respectively), the type of urinary diversion did not seem to influence rates of CDI in multivariate analysis (p=0.061). CONCLUSIONS The development of CDI occurs in up to 10% of patients undergoing radical cystectomy for bladder cancer. Our study demonstrates that preoperative use of antacid therapy, postoperative acute renal failure, and large cumulative intravenous antibiotic dosages are associated with the development of CDI. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e812-e813 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kashyap Shatagopam More articles by this author Nick Liu More articles by this author M. Francesca Monn More articles by this author Clinton Bahler More articles by this author Hristos Kaimakliotis More articles by this author K. Clint Cary More articles by this author Ronald Boris More articles by this author Matthew Mellon More articles by this author Timothy Masterson More articles by this author Richard Bihrle More articles by this author Richard Foster More articles by this author Thomas Gardner More articles by this author Michael House More articles by this author Michael Koch More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...