A RECENT single-centre, randomised, noninferiority trial has explored the effects of a 24-hour perioperative antibiotic course versus an extended regimen (median 8 days) for patients undergoing cystectomy with urinary diversion.
The findings revealed that a 24-hour antibiotic course was equally effective in preventing surgical site infections (SSIs) as the longer regimen. Other patient outcomes, including overall mortality, length of hospital stay, and incidence of febrile urinary tract infections, also showed no difference between groups. The 24-hour group did experience higher rates of asymptomatic bacteriuria, though this trend ceased once antibiotic treatment concluded.
Antibiotic stewardship, especially in surgical settings, aims to reduce adverse effects associated with prolonged antibiotic use, such as antibiotic resistance and infections from Clostridioides difficile. The study underscores the importance of balancing effective infection control with minimising unnecessary antibiotic exposure, especially as extended courses risk encouraging multi-drug resistance without added benefits in infection prevention. Antibiotic stewardship not only safeguards patient outcomes but also lowers hospital costs, length of stay, and adverse drug events.
Traditional protocols for cystectomy favoured prolonged antibiotics due to high infection rates. However, current American Urological Association (AUA) guidelines recommend single-dose prophylaxis with cefazolin or alternative agents, contrasting with the broader-spectrum regimen (tobramycin, metronidazole, and amoxicillin-clavulanate) used in the study. Despite concerns over potential differences in infection coverage, the study found no disparity in outcomes, suggesting a narrower antibiotic approach could be sufficient.
The study also examined asymptomatic bacteriuria, which is common after urinary diversion. Routine treatment for asymptomatic bacteriuria is generally discouraged unless symptoms like fever or flank pain arise. In line with best practices, withholding antibiotics for asymptomatic bacteriuria could prevent unnecessary antibiotic exposure.The findings suggest that in patients undergoing cystectomy, a 24-hour antibiotic course appears effective in infection prevention, aligning with best practices in antibiotic stewardship.
Reference
Skupin PA et al. 24-Hour perioperative antibiotic prophylaxis for cystectomy and urinary diversions-less is more. JAMA Netw Open. 2024;7(10):e2439361.
