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A comparison of antibiotic prophylaxis regimens to decrease the risk of post-procedure urinary tract infection after onabotulinum toxin A injection

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Abstract

Introduction and hypothesis

To evaluate the risk of post-injection urinary tract infection (UTI) after onabotulinumtoxin A (BTX-A) treatment based on the timing of when antibiotic prophylaxis is started.

Methods

This is a retrospective cohort study of 111 women with refractory idiopathic overactive bladder who underwent intradetrusor injection of BTX-A. Two cohorts were identified: (1) 67 women who started antibiotic prophylaxis with ciprofloxacin 1 day prior to injection; (2) 44 women who received antibiotic prophylaxis with ciprofloxacin after injection only. We assessed for post-injection UTI within 90 days after BTX-A. Multivariable logistic regression was performed to adjust for potential confounders.

Results

One hundred eleven women underwent BTX-A. In total, 30 (27%) had a UTI within 90 days; these included 15/67 (22%) of those who started antibiotics 1 day prior to injection and 15/44 (34%) of those receiving antibiotics after injection. While the unadjusted analysis showed no significant associations between timing of antibiotic administration and UTI (OR = 0.56; 95% CI = 0.24, 1.30; p = 0.18), an adjusted analysis showed the pre-procedure antibiotic group had a significant reduction in post-procedure UTI after controlling for age, history of UTI, diabetes, and urinary retention requiring catheterization (OR = 0.23; 95% CI = 0.07, 0.73; p = 0.01).

Conclusions

Starting antibiotics 1 day prior to BTX-A injection decreases the odds of post-injection UTI compared with women who use post-procedure antibiotic prophylaxis over shorter duration. Consideration should be given to beginning antibiotic prophylaxis prior to the procedure and continuing it for 4 total days to decrease the risk of UTI.

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Acknowledgements

The authors would like to thank Claire McLaughlin, BA, for her assistance with regulatory aspects of the study and manuscript editing.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA

    Jennifer A. Bickhaus, Monique Vaughan & Nazema Y. Siddiqui

  2. Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Saint Louis University, 6420 Clayton Road, Suite 290, St. Louis, MO, 63117, USA

    Jennifer A. Bickhaus

  3. Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA

    Tracy Truong & Yi-Ju Li

Authors
  1. Jennifer A. Bickhaus
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  2. Monique Vaughan
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  3. Tracy Truong
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  4. Yi-Ju Li
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  5. Nazema Y. Siddiqui
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Contributions

Bickhaus: project and protocol development, data collection, manuscript writing and editing, data analysis.

Vaughan: protocol development, data collection, manuscript writing and editing, data analysis.

Truong: protocol development, manuscript editing, data analysis.

Li: protocol development, manuscript editing, data analysis.

Siddiqui: project and protocol development, manuscript writing and editing, data analysis.

Corresponding author

Correspondence to Jennifer A. Bickhaus.

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Conflicts of interest

Dr. Siddiqui received research funding from Medtronic, Inc., which includes salary support. All other authors do not have any potential conflicts of interest to report.

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Bickhaus, J.A., Vaughan, M., Truong, T. et al. A comparison of antibiotic prophylaxis regimens to decrease the risk of post-procedure urinary tract infection after onabotulinum toxin A injection. Int Urogynecol J 31, 1907–1912 (2020). https://doi.org/10.1007/s00192-020-04230-7

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  • DOI: https://doi.org/10.1007/s00192-020-04230-7

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