Patients with bladder cancer may require a radical cystectomy for treatment. Formation of a neobladder as a continent urinary diversion is one option when having a radical cystectomy. Studies have shown that patients with a neobladder will frequently have positive urine cultures due to the presence of bacteria from the segment of the bowel used to create a new bladder. Two prospective studies in asymptomatic patients with neobladders have found that 57–81% of urine samples had bacterial levels of ≥104cfu/ml, in contrast to only 13% of urine samples from a control group. The current CDC CAUTI surveillance definition includes neobladder cases and is required to be reported.
Methods: Retrospective review of patients with a radical cystectomy with neobladder performed in 2013-2014 to investigate their urine microbiology data. Data collection included the review of surgical data reports, microbiology data reports, and chart reviews. Evaluation was also done to determine if the cases with positive urine cultures met the CDC CAUTI surveillance definition.
Results: From 2013 to 2014, Memorial Sloan Kettering Cancer Center performed 150 neobladder surgical cases resulting in 5 CDC defined CAUTIs post surgery. From 2013 and 2014, patients with previous neobladder surgery had continuously positive urine cultures up to 6 months after surgery. Out of the 81 neobladder cases done in 2014, 31 patients(38%) had at least one positive urine culture post surgery. Seven of these cases had multiple urine cultures positive for gastrointestinal bacteria up to 5 months post surgery.
Conclusion: Review of the data showed that patients with a neobladder continued to have bacteria in the urine after urinary diversion surgery. Since patients post neobladder surgery are at increased risk for bacteriuria and urinary track infections, it is difficult to establish if these cases are truly related to the catheter or a colonization of the urinary tract from their newly formed bladder.
J. Eagan, None
M. Kamboj, None