Antibiotic prophylaxis prior to urodynamic study in patients with traumatic spinal cord injury. Is there an indication?

Abstract

Study design: Retrospective cohort of patients with traumatic spinal cord injury (SCI) that have been hospitalized for physical-functional rehabilitation purposes. Objectives: To compare the incidence of urinary tract infection (UTI) after urodynamic study (UDS) in three hospitals that adopted different protocols with regard to the preparation of patients. Setting: Sarah Network of Rehabilitation Hospitals, Brazil. Materials and Methods: Between 2014 and 2015, 661 patients from three units of the same hospital network, one of which does not use antimicrobial prophylaxis independently of urine culture results, were evaluated after having undergone UDS. The results were compared in both univariate and multivariate analyses (logistic regression). Results: The global rate of UTI after UDS was that of 3.18% (IC 95% 2.1-4.8), with no differences between the units. In the univariate analysis the only variable that was associated with UTI after UDS was that of T6 injuries or above (P = 0.029). The logistic regression has confirmed this result, with an adjusted odds ratio of 3.06 (IC 95% 1.01 to 9.26; P = 0.0476). The use of antimicrobial prophylaxis did not alter that risk. Conclusions: This study has demonstrated that the use of antimicrobials does not prevent UTI after UDS. Patients with T6 traumatic SCI or above have got three times more chance of developing UTI after UDS if compared to those with a T7 injury or below, independently of the use of antimicrobials. Even in these patients the use of antimicrobials would not be justified.

Should We Delay Urodynamic Study When Patients With Spinal Cord Injury Have Asymptomatic Pyuria?

“…Although there is no consensus regarding the use of prophylactic antibiotics before UDS, it is recommended that prophylactic antibiotics should be used before all invasive procedures, including UDS in high-risk groups for UTI, similar to patients with SCI [9,[18][19][20][21][22]. Conversely, a retrospective study of 661 patients with SCI [23] showed no significant difference in the incidence of post-UDS UTI between groups using and not using prophylactic antibiotics, and concluded that prophylactic antibiotics should not be used. Although an exact comparison is lim-ited by the study design, the incidence of post-UDS UTI in our study (1.5%) was markedly lower than that in other studies (9.7%-15.8%) [6,16].…”

Letter to the Editor RE: Urodynamic findings and urologic management of central cord syndrome, J Clin Urol 11 September 2019

“…The authors are to be commended on this study, which further adds to the limited literature available on urodynamic findings in central cord syndrome. They do not state if antimicrobial prophylaxis was administered pre urodynamic evaluation, which has recently been debated, 2 or if any patient developed dysreflexia.…”

Re: Antibiotic prophylaxis prior to urodynamic study in patients with traumatic spinal cord injury. Is there an indication?

“…We read with interest the recent paper by da Silva et al examining effects of antibiotic prophylaxis and risk of urinary tract infection for spinal cord injured patients undergoing urodynamic studies. The authors describe a multi institutional study involving 661 patients who underwent urodynamic evaluation over 2 years ( 1 ). Three different antibiotic protocols are described in separate institutions and a cumulative infection rate of 3.18% was found.…”

“…No differences between patient age or ASIA classification were found to have an association with the development of subsequent urinary tract infection. However, patients with injuries at T6 or above were at increased risk of developing urinary tract infection following urodynamic evaluation ( 1 ).…”