Distribution of pathogens and antimicrobial resistance patterns in urinary tract infections following radical cystectomy and urinary diversion.

INTRODUCTION

There are no available data from Türkiye-a country known for high antimicrobial resistance rates-regarding the etiological distribution and resistance profiles of urinary tract infections (UTIs) developing after radical cystectomy. This lack of evidence constitutes an important gap in global microbiological epidemiology. In this study, we aimed to evaluate the etiological distribution and antimicrobial resistance patterns of UTIs developing after radical cystectomy and urinary diversion.

METHODS

Patients who underwent radical cystectomy at our center between January 2006 and December 2025 were retrospectively reviewed. A positive urine culture (≥105 CFU/mL) accompanied by concurrent clinical signs and symptoms was accepted as the diagnostic criterion for UTI. Clinical and microbiological data from the first postoperative UTI episode were analyzed.

RESULTS

A total of 56 patients (median age: 65 years) were included in the study. Sixty-two microorganisms were isolated from urine cultures; 77.4% were Gram-negative bacteria, 21.0% were Gram-positive bacteria, and 1.6% were fungi. The most frequently isolated microorganism was Escherichia coli (46.8%), followed by Enterococcus faecium (16.1%). Extended-spectrum beta-lactamase (ESBL) production was detected in 35.4% of Gram-negative isolates. Among enterococci, ampicillin resistance was 76.9% and gentamicin resistance was 53.8%.

CONCLUSIONS

Although Gram-negative bacteria predominated in UTIs developing after radical cystectomy, the high ESBL rate and notable frequency of E. faecium indicate that this patient population exhibits a complex resistance profile. Our findings demonstrate that UTIs following radical cystectomy possess a microbiological profile distinct from standard community-acquired infections and that empirical therapy should be planned by taking these specific resistance patterns into consideration.