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

Eckhardt, Sarah; Takashima, Yoko; Handler, Stephanie J.; Tenggardjaja, Christopher; Yazdany, Tajnoos

doi:10.1007/s00192-021-04691-4

Cited by 6 publications

(11 citation statements)

References 24 publications

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“…Eckhardt and colleagues evaluated 565 patients who underwent BTX-A injection and found no difference in UTI rate between those who did receive antibiotics and those who did not. 11 They also did not find any significant differences in UTI rates between various antibiotic regimens. It may be worth reconsidering if BTX-A injection should be included in the "cystoscopy with manipulation" category and whether a new category for BTX-A administration can be created.…”

Section: Resultsmentioning

confidence: 90%

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Antibiotic use, best practice statement adherence, and UTI rate for intradetrusor onabotulinumtoxin‐A injection for overactive bladder: A multi‐institutional collaboration from the SUFU Research Network (SURN)

Shapiro,

Anger,

Cameron

et al. 2023

Neurourology and Urodynamics

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IntroductionOnabotulinumtoxin A (BTX‐A) is a well‐established treatment for overactive bladder (OAB). The American Urological Association (AUA) 2008 Antibiotic Best Practice Statement (BPS) recommended trimethoprim‐sulfamethoxazole or fluoroquinolone for cystoscopy with manipulation. The aim of the study was to evaluate concordance with antibiotic best practices at the time of BTX‐A injection and urinary tract infection (UTI) rates based on antibiotic regimen.MethodsMen and women undergoing first‐time BTX‐A injection for idiopathic OAB with 100 units in 2016, within the SUFU Research Network (SURN) multi‐institutional retrospective database were included. Patients on suppressive antibiotics were excluded. The primary outcome was concordance of periprocedural antibiotic use with the AUA 2008 BPS antimicrobials of choice for “cystoscopy with manipulation.” As a secondary outcome we compared the incidence of UTI among women within 30 days after BTX‐A administration. Each outcome was further stratified by procedure setting (office vs. operating room; OR).ResultsOf the cohort of 216 subjects (175 women, 41 men) undergoing BTX‐A, 24 different periprocedural antibiotic regimens were utilized, and 98 (45%) underwent BTX‐A injections in the OR setting while 118 (55%) underwent BTX‐A injection in the office. Antibiotics were given to 86% of patients in the OR versus 77% in office, and 8.3% of subjects received BPS concordant antibiotics in the OR versus 82% in office. UTI rates did not vary significantly among the 141 subjects who received antibiotics and had 30‐day follow‐up (8% BPS‐concordant vs. 16% BPS‐discordant, CI −2.4% to 19%, p = 0.13). A sensitivity analysis of UTI rates based on procedure setting (office vs. OR) did not demonstrate any difference in UTI rates (p = 0.14).ConclusionsThis retrospective multi‐institutional study demonstrates that antibiotic regimens and adherence to the 2008 AUA BPS were highly variable among providers with lower rates of BPS concordant antibiotic use in the OR setting. UTI rates at 30 days following BTX‐A did not vary significantly based on concordance with the BPS or procedure setting.

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Section: Resultsmentioning

confidence: 90%

“…Other studies have found similar results. Eckhardt and colleagues evaluated 565 patients who underwent BTX‐A injection and found no difference in UTI rate between those who did receive antibiotics and those who did not 11 . They also did not find any significant differences in UTI rates between various antibiotic regimens.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic use, best practice statement adherence, and UTI rate for intradetrusor onabotulinumtoxin‐A injection for overactive bladder: A multi‐institutional collaboration from the SUFU Research Network (SURN)

Shapiro,

Anger,

Cameron

et al. 2023

Neurourology and Urodynamics

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“…Urodynamics may be employed in patients with There is a lack of specific antimicrobial prophylaxis recommendations for intravesical BoNT injections. 14 A recent American Urology Association -Best Practice Statement recommends a single dose of prophylaxis for any procedure with potential violation of the genitourinary tract but offers no procedure specific guidance. 15 Although most respondents (66.4%) provide routine antimicrobial prophylaxis, antibiotic regimens and durations vary widely.…”

Section: Discussionmentioning

confidence: 99%

“…16 Another study found no difference in infection when comparing antimicrobial type or route of administration. 14 Further study is required to champion antimicrobial stewardship and identify the optimal regimen and duration of prophylaxis for intravesical BoNT.…”

Section: Discussionmentioning

confidence: 99%

Intravesical botulinum toxin: Practice patterns from a survey of Canadian urologists

Ross

Hickling²,

Maciejewski³

et al. 2022

CUAJ

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Introduction: The objectives of this study were to conduct a survey of intravesical botulinum toxin administration practices in Canada, to compare practices based on level of training, and to identify barriers to delivery. Methods: A voluntary online survey was sent to all members of the Canadian Urology Association. Respondents who provide intravesical botulinum toxin were questioned on training, surgical volume, workup, technique, and followup practices. Those with formal training in functional urology were compared to those without. Barriers to treatment delivery were identified. Results: The overall response rate was 26% (148/570). Most providers (59%) perform one to 10 treatments/month. Preoperatively, 51% perform cystoscopy and 43% perform urodynamics. A majority (66%) give routine antimicrobial prophylaxis; however, regimen and duration varied. Most (79%) perform some treatments under local anaesthetic, and 66% instill lidocaine solution for analgesia. There was a wide variation in technique with regards to the number of injections administered (range <10 to >20), volume administered per injection (range 0.5 mL to 2 mL), location of injections (bladder body vs. trigone vs. both), and depth of injection. Postoperative followup ranged from three days to three months. Respondents with fellowship training in functional/reconstructive urology performed more treatments per month and administered fewer injections per treatment. Common barriers to delivery included lack of experience/training among non-providers (45%), lack of resources (34%), and lack of medication funding (32%). Conclusions: Despite intravesical botulinum toxin being a widely accepted treatment, significant variability in practices and several barriers to delivery exist in Canada. Further study is required to optimize treatment access and quality.

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“…Prior studies have demonstrated that UTI occurs in 8.6% to 48.1% of patients, between 1 and 6 months after the procedure. [22][23][24][25] Despite the known high rates of UTI, research has been limited to only 4 small, retrospective studies regarding variable antibiotic regimens, timing of initiation, duration, dose, and choice of antibiotics at the time of intradetrusor onabotulinumtoxinA injections. [22][23][24][25] The onabotu-linumtoxinA pharmaceutical package insert states that "oral prophylactic antibiotics, except aminoglycosides, should be administered 1 to 3 days pretreatment, on the treatment day, and 1 to 3 days posttreatment to reduce the likelihood of procedure-related UTI."…”

Section: Why This Mattersmentioning

confidence: 99%

Antibiotics for UTI Prevention After Intradetrusor OnabotulinumtoxinA Injections

Heuer,

Gisseman,

Vaccaro

et al. 2024

UROGC

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Importance Urinary tract infections (UTIs) occur in 8.6% to 48.1% of patients after intradetrusor onabotulinumtoxinA injections. Objective The objective of this study was to evaluate both choice and duration of antibiotic prophylaxis on the incidence of UTI within 30 days after in-office onabotulinumtoxinA injections. Study Design We included a single-site, retrospective cohort of 305 patients with overactive bladder or bladder pain syndrome receiving postprocedure prophylactic antibiotics for in-office, 100-unit intradetrusor onabotulinumtoxinA injections from 2019 to 2023. Categories of antibiotic prophylaxis compared included (1) nitrofurantoin 100 mg twice daily for 3 days, (2) nitrofurantoin 100 mg twice daily for 5 days, (3) trimethoprim-sulfamethoxazole 160 mg/800 mg twice daily for 3 days, and (4) “other regimens.” Primary outcome was incidence of UTI within 30 days. Variables were compared via χ 2 test. Crude/adjusted odds were estimated using binary logistic regression. Results Incidence of UTI was 10.4% for 3-day nitrofurantoin, 20.5% for 5-day nitrofurantoin, 7.4% for 3-day trimethoprim-sulfamethoxazole, and 25.7% among “other regimens” (P = 0.023). Differences among primary regimens were substantial but not statistically significant: 3-day trimethoprim-sulfamethoxazole had 31% lower odds of UTI versus 3-day nitrofurantoin (odds ratio [OR], 0.689; P = 0.518). Compared with 3-day nitrofurantoin regimen, the 5-day nitrofurantoin regimen had twice the odds of UTI (OR, 2.22; P = 0.088). Those receiving “other regimens” had nearly 3 times the odds of UTI (OR, 2.98; P = 0.018). Results were similar adjusting for age and race. Overall urinary retention rate was 1.97%. Conclusions Prophylactic antibiotic choice and duration of treatment potentially affect UTI incidence after in-office, intradetrusor onabotulinumtoxinA injections. Nitrofurantoin and trimethoprim-sulfamethoxazole for 3 days have the lowest UTI incidence.

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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

Cited by 6 publications

References 24 publications

Antibiotic use, best practice statement adherence, and UTI rate for intradetrusor onabotulinumtoxin‐A injection for overactive bladder: A multi‐institutional collaboration from the SUFU Research Network (SURN)

Antibiotic use, best practice statement adherence, and UTI rate for intradetrusor onabotulinumtoxin‐A injection for overactive bladder: A multi‐institutional collaboration from the SUFU Research Network (SURN)

Intravesical botulinum toxin: Practice patterns from a survey of Canadian urologists

Antibiotics for UTI Prevention After Intradetrusor OnabotulinumtoxinA Injections

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