Preoperative oral and postoperative parenteral antibiotic prophylaxis of wound infection in total cystectomy with ileal urinary diversion.

We describe an investigation of postoperative abdominal infectious complications and discuss two regimens for preoperative antibiotic bowel preparation in cases who underwent total cystectomy with ileal urinary diversion. Ten cases (28.6%) of 35 who had been operated developed abdominal infectious complications. Six showed abdominal wound infection, 2 showed intrapelvic abscess and 2 showed abdominal wound infection with intrapelvic abscess. Of the 19 strains of organisms isolated from the postoperative infections, 11 (57.9%) were anaerobic bacteria and the most commonly isolated bacteria was Bacteroides. A significantly lower incidence of postoperative infection was found in cases who had received tobramycin and vancomycin (0%) than in those who had received kanamycin alone (41.7%). These results indicate that anaerobic bacteria are the major contributors to postoperative infections following total cystectomy with ileal urinary diversion and that tobramycin-vancomycin prophylaxis greatly reduces the incidence of postoperative infections.