Vol.:(0123456789) 1 3 World Journal of Urology (2018) 36:775–781 https://doi.org/10.1007/s00345-018-2181-2 ORIGINAL ARTICLE Urinary tract infections following radical cystectomy and urinary diversion: a review of 1133 patients Thomas G. Cliford 1  · Behrod Katebian 1  · Christine M. Van Horn 1  · Soroush T. Bazargani 1  · Jie Cai 1  · Gus Miranda 1  · Siamak Daneshmand 1  · Hooman Djaladat 1 Received: 7 September 2017 / Accepted: 5 January 2018 / Published online: 25 January 2018 © Springer-Verlag GmbH Germany, part of Springer Nature 2018 Abstract Objective To investigate the incidence and microbiology of urinary tract infection (UTI) within 90 days following radical cystectomy (RC) and urinary diversion. Methods We reviewed 1133 patients who underwent RC for bladder cancer at our institution between 2003 and 2013; 815 patients (72%) underwent orthotopic diversion, 274 (24%) ileal conduit, and 44 (4%) continent cutaneous diversion. 90-day postoperative UTI incidence, culture results, antibiotic sensitivity/resistance and treatment were recorded through retrospec- tive review. Fisher’s exact test, Kruskal–Wallis test, and multivariable analysis were performed. Results A total of 151 urinary tract infections were recorded in 123 patients (11%) during the frst 90 days postoperatively. 21/123 (17%) had multiple infections and 25 (20%) had urosepsis in this time span. Gram-negative rods were the most com- mon etiology (54% of positive cultures). 52% of UTI episodes led to readmission. There was no signifcant diference in UTI rate, etiologic microbiology (Gram-negative rods, Gram-positive cocci, fungi), or antibiotic sensitivity and resistance pat- terns between diversion groups. Resistance to quinolones was evident in 87.5% of Gram-positive and 35% of Gram-negative bacteria. In multivariable analysis, Charlson Comorbidity Index > 2 was associated with higher 90-day UTI rate (OR = 1.8, 95% CI 1.1–2.9, p = 0.05) and Candida UTI (OR 5.6, 95% CI 1.6–26.5, p = 0.04). Conclusions UTI is a common complication and cause of readmission following radical cystectomy and urinary diversion. These infections are commonly caused by Gram-negative rods. High comorbidity index is an independent risk factor for postoperative UTI, but diversion type is not. Keywords Radical cystectomy · Urinary diversion · Complications · Urinary tract infection Introduction Radical cystectomy (RC) and urinary diversion is a major urological surgery associated with minor to potentially life- threatening complications. Common early complications include infection, gastrointestinal problems, and wound- related issues. Infection, especially urinary tract infection (UTI), is one of the most common complications following RC. Studies have characterized the organisms that most frequently colo- nize orthotopic neobladders (ONB), continent cutaneous diversions (CCD), and ileal conduits (IC) [1]. 30–80% of patients with ONB have bacteriuria, most commonly with Escherichia coli [2–5]. Nearly all patients with IC and CCD have chronic bacteriuria [1, 5]. Conduit urine culture may show Gram-positive mixed skin fora as well as uropatho- genic Gram-negative Enterobacteriaceae [5]. While simi- lar organisms are found in catheterizable intestinal pouches, Escherichia coli is the most frequently identifed organism [1]. The diagnosis of UTI in patients with urinary diver- sion is complicated by its vague presentation and lack of a standardized defnition in the literature. Patients range from asymptomatic to septic on presentation; possible symptoms include fever, chills, lower abdominal or fank pain, dysu- ria, and changes in the urine’s appearance and smell [6]. UTI rates after RC range from 5.7 to 44% [6, 7]. However, the literature lacks a thorough review of UTI complications after RC, association with specifc diversion, and etiologic * Hooman Djaladat djaladat@med.usc.edu 1 USC Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA 90089, USA