Pre-Cystectomy Chemo Not Associated With Increased C. Difficile Risk
New study also reveals no significant association between infection and use of proton pump inhibitors and peri-operative antibiotic redosing.
SAN DIEGO—Patients who receive neoadjuvant chemotherapy prior to radical cystectomy (RC) for bladder cancer are not at increased risk for post-operative Clostridium difficile infection, researchers reported at the recently-held American Urological Association annual meeting.
Previous studies have shown that RC alone and just having cancer increases the risk of C. difficile infection, lead investigator Katherine J. Cotter, MD, noted. “With the added component of immunosuppression from neoadjuvant chemotherapy, our hypothesis was that this factor may increase C. difficile incidence,” she said.
Dr Cotter and her colleagues at the University of Minnesota in Minneapolis studied 144 patients undergoing RC. Of these, 14 (12%) experienced C. difficile infection within 30 days post-operatively, a rate higher than the 1.7% to 8.8% rate reported in the literature. C. difficile infection developed in 6 (12.2%) of the 49 patients who received neoadjuvant chemotherapy and 8 (8.4%) of the RC-only patients, a non-significant difference between the groups.
In addition, Dr Cotter's group found no significant association between infection and pre- or post-operative use of proton pump inhibitors and peri-operative antibiotic redosing.
The median time to C. difficile diagnosis was 6 days: 5.5 days in the post-chemotherapy group and 7 days in the RC-only group; the median length of hospital stay was 8.7 days in the post-chemotherapy group and 10.9 days in the RC-only group. None of these differences were significant.