Effect of antibiotics on enterocystoplasty urinary nitrosamine levels

Objectives. To evaluate the microbiologic characteristics of enterocystopla sty urine and assess the influence of bacteria type and effect of prophylac tic and therapeutic antibiotic administration on the urinary nitrosamine le vels of patients with enterocystoplasty. Nitrosamines have been implicated in the development of cancer in patients with an enterocystoplasty. Urinary tract infection (UTI) is associated with elevated nitrosamine levels. Methods. Urine samples were collected to determine the urinary nitrosamine levels and for microscopy, culture, and sensitivity from 42 patients with a n enterocystoplasty and 6 normal controls. A subgroup of 5 enterocystoplast y patients with proven UTI was also evaluated by measuring the urinary nitr osamine levels before and after a therapeutic course of antibiotics. Results. Of the 42 cystoplasty patients, 22 had a proven UTI; none of the c ontrols had one. Sixteen of the cystoplasty patients were taking prophylact ic antibiotics and had mean N-nitrosamine levels equivalent to the control levels. The mean nitrosamine levels were highest in patients with a UTI (1. 9 mu mol/L). Escherichia coli was the most common infecting organism (11 pa tients) and resulted in the highest mean nitrosamine levels (2.1 mu mol/L). The nitrosamine levels fell with UTI treatment to within the control range . Conclusions. UTI occurs in 51% of enterocystoplasty patients and is associa ted with elevated mean urinary nitrosamine levels. E. coli is the infecting organism in 50% of cases. Antibiotic prophylaxis reduces the nitrosamine l evels to those of the controls. UTI treatment results in a rapid reduction of elevated nitrosamine levels to control levels. (C) 2001, Elsevier Scienc e Inc.