Résumé
To determine the value (measured by the number of post operative infections) of UC (urine culture positive or sterile) and antibiotic prophylaxis performed before partial nephrectomy (PN) for cancer to decrease the postoperative risk of infection.
This study included a prospective cohort of patients who underwent PN for cancer between 2011 and 2023. Multivariate logistic regression was performed to investigate risk factors associated with the occurrence of postoperative infection episodes. Post operative infections were defined accordingly to the CDC (Center for disease control and prevention) definition (fever > 38°5 C that required antibiotics, superficial/deep wound infection requiring medical or surgical intervention, or urinary infection treated by antibiotics during the month after surgery). A propensity score was calculated. A logistic regression model weighted by the propensity score was defined.
Preoperative UC was performed for 491 of the 702 patients (69.9%); 78.4% were sterile, 21.6% positive (13.9% polymicrobial). A total of 637 patients (90.7%) did not receive preoperative antibiotic prophylaxis in accordance with our national guidelines. Forty patients out of 702 (5.7%) had a documented infection postoperatively. All the documented infections were urinary tract infections. None of the patients had any pulmonary or abdominal infections. According to the multivariate analysis, neither antibiotic prophylaxis nor UC performed before the procedure were significantly associated with an increased risk of postoperative infection. After adjustment for the propensity score, the relationship between preoperative UC and postoperative infection incidence was estimated by an odds ratio of 1.12 (0.76-1.65).
Our study confirmed for the first time that neither antibiotic prophylaxis nor preoperative UC reduces the risk of infection following PN.