Modifying the Enhanced Recovery After Surgery (ERAS) protocol to include intracorporeal urinary diversion and antibiogram-directed antimicrobial prophylaxis may decrease infections after robotic-assisted radical cystectomy (RARC) for bladder cancer. Investigators presented the new study findings in a poster at the Society of Urologic Oncology’s 24th Annual Meeting in Washington, DC.

Among 396 patients at Mount Sinai hospital in New York City undergoing RARC, 138 patients (34.8%) received extracorporeal urinary diversion and a guideline recommended cephalosporin-based prophylaxis regimen and 258 patients (65.2%) received intracorporeal urinary diversion and antibiogram-directed antimicrobial prophylaxis. The antibiogram was created after institutional review of postoperative urine culture data from patients previously receiving RARC at the hospital and highlighted ampicillin-sulbactam, gentamicin, and fluconazole prophylaxis.

On multivariate regression, the modified-ERAS protocol was significantly associated with reduced risks of urinary tract and wound infections, Jordan Miller Rich, MD, and colleagues from the Icahn School of Medicine at Mount Sinai reported. The group receiving the modified ERAS protocol had significantly lower rates of urinary tract infections at 30 days (7.8% vs 15.9%) and 90 days (11.2% vs 25.4%). The modified ERAS group also had significantly lower rates of wound infections within 30 days (1.2% vs 8.7%). Rates of intraabdominal infections, sepsis, and Clostridioides difficile did not differ between groups.

“Further prospective trials are necessary to corroborate these findings and come to consensus regarding optimal perioperative prophylaxis and diversion approach for reducing infectious complications after RARC,” according to Dr Miller’s team.

Antibiograms, Intracorporeal Diversion Cut Infection Risks After Radical Cystectomy

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