Prospective Evaluation of Blood-based and Microbiological Early Indicators of In-hospital Infectious Complications After Open Cystectomy.

Background and objective: In-hospital infectious complications after cystectomy are understudied, with no reliable predictive tools. The aim of our study was to (1) comprehensively and prospectively evaluate these complications, (2) compare results between ileal conduit (IC) and ileal neobladder (NB) groups, and (3) evaluate the suitability of interleukin-6 (IL-6) and procalcitonin (PCT) levels and culture results for wound drainage fluid (WDF) as early indicators of infection. Methods: We monitored in-hospital complications among patients undergoing cystectomy and analyzed IL-6 and PCT levels and WDF cultures on the first postoperative day. Statistical analysis included logistic regression and Spearman correlation analysis. The trial was registered on ClinicalTrials.gov as NCT05153694. Key findings and limitations: From December 2021 to October 2024, 205 patients underwent open cystectomy in our department, of whom 186 consented to participate (66% IC, 34% NB). The median patient age was 71.6 yr and 80% were male. During their inpatient stay, 47% of patients developed fever and 44% received additional intravenous antibiotics. We found no significant differences between the IC and NB groups regarding postoperative fever, additional antibiotic use, positive blood cultures, the incidence of complications by Clavien-Dindo grade, Comprehensive Complication Index scores, or the incidence of wound infection or other infections. Microbial growth was detected in 13% of WDF samples; Escherichia coli and Enterococcus spp. were the most prevalent bacteria. We observed little to no correlations between IL-6 or PCT levels or WDF culture results and infectious complications. Conclusions and clinical implications: Our prospective study revealed unexpectedly high incidence of in-hospital infections among cystectomy patients, with no significant differences between IC and NB groups. IL-6 and PCT levels and WDF culture results on the first postoperative day were not suitable as early indicators of infectious complications after open cystectomy. Patient summary: We looked at infectious complications during their hospital stay for patients undergoing surgical removal of their bladder. We found no difference in the rate of infectious complications between two common surgical procedures that create a new pathway for urine to leave the body. We also found that levels of the markers interleukin-6 and procalcitonin, and bacterial culture results for wound drainage fluid were not helpful in predicting infectious complications for these patients.