Urinary tractinfection after cystectomy with continent orthotopic diversion – Vesica ileale padovana (V.I.P.)
Authors:
Petr Morávek jr. 1; Petr Morávek 1; Miroslav Louda 1; Miloš Broďák 1; Monika Morávková 2
Authors‘ workplace:
Urologická klinika LF UK a FN, Hradec Králové
1; Ústav klinické mikrobiologie LF UK a FN, Hradec Králové
2
Published in:
Ces Urol 2010; 14(3): 173-179
Category:
Original article
Overview
Aim:
The verification of microbial findings in the urine of the patients after a cystectomy with urinary tract reconstruction using ileum and determining sensitivity to antimicrobial drugs and ways of the protection. According to results we plan to propose the appropriate prophylaxis. The suitability of subsequent therapy in postoperative period has been consulted with Department of Clinical Microbiology.
Material and method:
The authors evaluated the cohort of 31 patients after cystectomy with continent derivation of urine in modification Vesica Ileale Padovana (V.I.P.), who underwent surgery on Department of Urology in Hradec Kralove. Quantitative bacteriuria, sensitivity to antimicrobial drugs and efficiency of administered antimicrobial therapy were examined in one, three and six month interval.
Results:
Bacteriuria was present in 35.5 % of patients in the postoperative period. Escherichia coli were the most common finding, sensitive to all common antibiotics. The sensitivity of others microbes as Pseudomonas aeruginosa, Enterococcus faecalis and Klebsiella pneumoniae was only to high generation of cephalosporines, aminoglycosides or another more toxic antibiotics. Despite targeted therapy, bacteriuria was repeatedly positive in 77.4 % of patients, but clinically asymptomatic.
Conclusion:
Quinelones, Trimethoprim + Sulfamethoxazolum or Ampicillin with beta-lactamase inhibitors (i.v.) in combination with metronidazolum one hour before and 7–10 days after operation can be used to cover the serious operation. Asymptomatic bacteriuria is not necessary to treat. In the case of infection with clinical sings of sepsis or pyelonephritis, it is necessary to immediately initiate antibiotic therapy according to the sensitivity to antimicrobial agents.
Key words:
ileal neobladder (V.I.P.), bacteriuria, therapy.
Sources
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Labels
Paediatric urologist Nephrology UrologyArticle was published in
Czech Urology
2010 Issue 3
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