Perioperative antibiotics in radical cystectomy with ileal conduit urinary diversion: efficacy and risk of antimicrobial prophylaxis on the operation day alone.

OBJECTIVE: To determine the optimum schedule for perioperative antimicrobial prophylaxis (AMP) for bladder cancer patients submitted to radical cystectomy with ileal conduit urinary diversion.
METHODS: We studied 77 consecutive bladder cancer patients who underwent radical cystectomy with ileal conduit. The 1-day group (n = 33) received pre-, intra- and postoperative administrations of 2 g of piperacillin on the operation day alone; the 3-day group (n = 44) received antibiotics for 3 days or more (same schedule as the 1-day group on the operation day and every 12 h thereafter). The study was designed and postoperative complications including surgical-site infection (SSI) were defined according to the modified Centers for Disease Control and Prevention criteria.
RESULTS: No significant differences were found between the 1-day group and 3-day group in terms of total SSI (18.1% vs 20.5%), superficial incisional SSI (12.1% vs 13.6%), deep incisional SSI (12.1% vs 13.6%), space SSI (12.1% vs 11.4%), postoperative ileus (18.2% vs 11.4%), febrile urinary tract infections (15.2% vs 15.9%) or pneumonia (3.0% vs 4.3%), respectively. In both groups, disease stage and patients' underlying conditions such as diabetes did not have an influence on the incidence of postoperative complications.
CONCLUSION: One-day AMP had equivalent efficacy to that of the standard prophylaxis protocol for preventing septic complications following radical cystectomy with ileal conduit. This finding supports the hypothesis that delivery of antibiotics on the operation day is critical in this setting.