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Antibiotic regimen and route of administration do not alter rates of urinary tract infection after intravesical botulinum toxin injection for overactive bladder

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Abstract

Introduction and hypothesis

Guidelines vary on antibiotic prophylaxis for onabotulinumtoxinA (Botox) treatment for overactive bladder (OAB). Our primary objective was to determine whether any prophylactic regimen is more effective in preventing urinary tract infection (UTI) after Botox. The secondary objective was to identify prophylactic practice patterns among female pelvic medicine and reconstructive surgery (FPMRS) providers of different training backgrounds as well as general urologists.

Methods

This was a secondary analysis of a retrospective cohort study on urinary retention after Botox injection in women with and without diabetes mellitus and OAB. Women > 18 years old who underwent Botox injection for OAB between January 2013 and September 2018 were included. Exclusion criteria were history of urinary retention and neuromuscular bladder dysfunction.

Results

A total of 565 patients were included. Two hundred eighty (49.6%) were treated by OB-GYN FPMRS, 209 (37.0%) by urology FPMRS and 76 (13.5%) by general urologists. The majority (92.9%) received antibiotic prophylaxis: 44.4% received intravenous (IV) only, 8.9% received oral (PO) only, and 39.7% received combination IV and PO prophylaxis. Urology FPMRS used antibiotic prophylaxis less frequently (p = 0.003). Within 3 months, 171 patients developed UTI (30.4%). There was no difference in post-procedural UTI for any antibiotic regimen compared to no prophylaxis. No route of antibiotic administration was superior at preventing UTI.

Conclusions

In this cohort, no route of antibiotic administration was more effective in the prevention of UTI. Antibiotic prophylaxis did not lower the rate of post-procedural UTI compared to no antibiotics.

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References

  1. South M, Karram M. Overactive bladder syndrome and nocturia. In: Walters M, Karram M, editors. Urogynecology and reconstructive pelvic surgery. Philadelphia: Saunders; 2015. p. 513–5.

    Google Scholar 

  2. Stewart WF, Van Rooyen JB, Cundiff GW, et al. Prevalence and burden of overactive bladder in the United States. World J Urol. 2003;20(6):327–36. https://doi.org/10.1007/s00345-002-0301-4.

    Article  CAS  PubMed  Google Scholar 

  3. Harris SS, Link CL, Tennstedt SL, Kusek JW, McKinlay JB. Care seeking and treatment for urinary incontinence in a diverse population. J Urol. 2007;177(2):680–4. https://doi.org/10.1016/j.juro.2006.09.045.

    Article  PubMed  Google Scholar 

  4. Schurch B, Stöhrer M, Kramer G, Schmid DM, Gaul G, Hauri D. Botulinum-A toxin for treating detrusor hyperreflexia in spinal cord injured patients: a new alternative to anticholinergic drugs? Preliminary results. J Urol. 2000;164(3 Pt 1):692–7. https://doi.org/10.1097/00005392-200009010-00018.

    Article  CAS  PubMed  Google Scholar 

  5. Brubaker L, Richter HE, Visco A, et al. Refractory idiopathic urge urinary incontinence and botulinum A injection. J Urol. 2008;180(1):217–22. https://doi.org/10.1016/j.juro.2008.03.028.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Sahai A, Khan MS, Dasgupta P. Efficacy of botulinum toxin-A for treating idiopathic detrusor overactivity: results from a single center, randomized, double-blind, placebo controlled trial. J Urol. 2007;177(6):2231–6. https://doi.org/10.1016/j.juro.2007.01.130.

    Article  CAS  PubMed  Google Scholar 

  7. Visco AG, Brubaker L, Richter HE, et al. Anticholinergic versus botulinum toxin A comparison trial for the treatment of bothersome urge urinary incontinence: ABC trial. Contemp Clin Trials. 2012;33(1):184–96. https://doi.org/10.1016/j.cct.2011.09.019.

    Article  CAS  PubMed  Google Scholar 

  8. Amundsen CL, Richter HE, Menefee SA, et al. OnabotulinumtoxinA vs sacral neuromodulation on refractory urgency urinary incontinence in women: a randomized clinical trial. JAMA. 2016;316(13):1366–74. https://doi.org/10.1001/jama.2016.14617.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Altaweel W, Mokhtar A, Rabah DM. Prospective randomized trial of 100u vs 200u botox in the treatment of idiopathic overactive bladder. Urol Ann. 2011;3(2):66–70. https://doi.org/10.4103/0974-7796.82170.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Chapple C, Sievert KD, MacDiarmid S, et al. OnabotulinumtoxinA 100 U significantly improves all idiopathic overactive bladder symptoms and quality of life in patients with overactive bladder and urinary incontinence: a randomised, double-blind, placebo-controlled trial. Eur Urol. 2013;64(2):249–56. https://doi.org/10.1016/j.eururo.2013.04.001.

    Article  CAS  PubMed  Google Scholar 

  11. Denys P, Le Normand L, Ghout I, et al. Efficacy and safety of low doses of onabotulinumtoxinA for the treatment of refractory idiopathic overactive bladder: a multicentre, double-blind, randomised, placebo-controlled dose-ranging study. Eur Urol. 2012;61(3):520–9.

    Article  CAS  Google Scholar 

  12. Dmochowski R, Chapple C, Nitti VW, et al. Efficacy and safety of onabotulinumtoxinA for idiopathic overactive bladder: a double-blind, placebo controlled, randomized, dose ranging trial. J Urol. 2010;184(6):2416–22. https://doi.org/10.1016/j.juro.2010.08.021.

    Article  CAS  PubMed  Google Scholar 

  13. Flynn MK, Amundsen CL, Perevich M, Liu F, Webster GD. Outcome of a randomized, double-blind, placebo controlled trial of botulinum A toxin for refractory overactive bladder. J Urol. 2009;181(6):2608–15. https://doi.org/10.1016/j.juro.2009.01.117.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Jabs C, Carleton E. Efficacy of botulinum toxin a intradetrusor injections for non-neurogenic urinary urge incontinence: a randomized double-blind controlled trial. J Obstet Gynaecol Can. 2013;35(1):53–60. https://doi.org/10.1016/s1701-2163(15)31049-5.

    Article  PubMed  Google Scholar 

  15. Tincello DG, Kenyon S, Abrams KR, et al. Botulinum toxin a versus placebo for refractory detrusor overactivity in women: a randomised blinded placebo-controlled trial of 240 women (the RELAX study). Eur Urol. 2012;62(3):507–14. https://doi.org/10.1016/j.eururo.2011.12.056.

    Article  CAS  PubMed  Google Scholar 

  16. Gormley EA, Lightner DJ, Faraday M, Vasavada SP, American Urological Association; Society of Urodynamics, Female Pelvic Medicine. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline amendment. J Urol. 2015;193(5):1572–80. https://doi.org/10.1016/j.juro.2015.01.087.

    Article  PubMed  Google Scholar 

  17. Allergan. (2019, October 1). BOTOX Cosmetic (onabotulinumtoxinA) for injection, for intramuscular use. Retrieved May 6, 2020, from https://media.allergan.com/actavis/actavis/media/allergan-pdf-documents/product-prescribing/20190626-BOTOX-Cosmetic-Insert-72715US10-Med-Guide-v2-0MG1145.pdf

  18. American Urogynecologic Society and American College of Obstetricians and Gynecologists. Committee opinion: onabotulinumtoxinA and the bladder. Female Pelvic Med Reconstr Surg. 2014;20(5):245–7. https://doi.org/10.1097/SPV.0000000000000112.

    Article  Google Scholar 

  19. Apostolidis A, Dasgupta P, Denys P, et al. Recommendations on the use of botulinum toxin in the treatment of lower urinary tract disorders and pelvic floor dysfunctions: a European consensus report. Eur Urol. 2009;55(1):100–19. https://doi.org/10.1016/j.eururo.2008.09.009.

    Article  PubMed  Google Scholar 

  20. Wolf JS Jr, Bennett CJ, Dmochowski RR, et al. Best practice policy statement on urologic surgery antimicrobial prophylaxis [published correction appears in J Urol. 2008 Nov;180(5):2262-3]. J Urol. 2008;179(4):1379–90. https://doi.org/10.1016/j.juro.2008.01.068.

    Article  PubMed  Google Scholar 

  21. Lightner DJ, Wymer K, Sanchez J, Kavoussi L. Best practice statement on urologic procedures and antimicrobial prophylaxis. J Urol. 2020;203(2):351–6. https://doi.org/10.1097/JU.0000000000000509.

    Article  PubMed  Google Scholar 

  22. Khan MH, Baldo O, Koenig P, Shaikh N. Use of prophylactic antibiotics for intra-vesicle Botox® injection. Neurourol Urodyn. 2017;36(3):828. https://doi.org/10.1002/nau.23034.

    Article  PubMed  Google Scholar 

  23. Houman J, Moradzadeh A, Patel DN, Asanad K, Anger JT, Eilber KS. What is the ideal antibiotic prophylaxis for intravesically administered Botox injection? A comparison of two different regimens. Int Urogynecol J. 2019;30(5):701–4. https://doi.org/10.1007/s00192-018-3721-4.

    Article  PubMed  Google Scholar 

  24. Leitner L, Sammer U, Walter M, et al. Antibiotic prophylaxis may not be necessary in patients with asymptomatic bacteriuria undergoing intradetrusor onabotulinumtoxinA injections for neurogenic detrusor overactivity. Sci Rep. 2016;6:33197. Published 2016 Sep 12. https://doi.org/10.1038/srep33197.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Mouttalib S, Khan S, Castel-Lacanal E, et al. Risk of urinary tract infection after detrusor botulinum toxin A injections for refractory neurogenic detrusor overactivity in patients with no antibiotic treatment. BJU Int. 2010;106(11):1677–80. https://doi.org/10.1111/j.1464-410X.2010.09435.x.

    Article  PubMed  Google Scholar 

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Acknowledgments

This work was presented as an abstract to the American Urogynecologic Society’s Pelvic Floor Disorders Week on 10 October 2020.

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Authors and Affiliations

  1. Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, 1000 W. Carson Street, Torrance, CA, 90509, USA

    Sarah E. Eckhardt, Yoko Takashima, Stephanie J. Handler & Tajnoos Yazdany

  2. Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Urology, Kaiser Permanente, Los Angeles, CA, USA

    Christopher Tenggardjaja

Authors
  1. Sarah E. Eckhardt
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  2. Yoko Takashima
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Contributions

SE Eckhardt: Data analysis, manuscript writing.

Y Takashima: Project development, data collection, manuscript writing.

S Handler: Data collection, manuscript writing.

C Tenggardjaja: Project development, data collection, manuscript writing.

T Yazdany: Project development, data collection, manuscript writing.

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Correspondence to Sarah E. Eckhardt.

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Eckhardt, S.E., Takashima, Y., Handler, S.J. et al. Antibiotic regimen and route of administration do not alter rates of urinary tract infection after intravesical botulinum toxin injection for overactive bladder. Int Urogynecol J 33, 703–709 (2022). https://doi.org/10.1007/s00192-021-04691-4

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  • DOI: https://doi.org/10.1007/s00192-021-04691-4

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