Prophylactic Antibiotics for Urinary Tract Infections after Urodynamic Studies: A Meta-Analysis

Abstract

Aim. We aimed to perform a meta-analysis to determine whether antibiotic prophylaxis reduces the incidence of urinary tract infections (UTIs) after urodynamic studies (UDS). Methods. We conducted a systematic search of PubMed, Web of Science, Ovid, Elsevier, ClinicalKey, Embase, Cochrane Library, Medline, and Wiley Online Library. Randomized controlled trials (RCTs) comparing the effectiveness of prophylactic antibiotics with placebo or no treatment in preventing UTI after UDS were included. Two reviewers extracted data independently, and RevMan 5.3 software was used to analyze relative risk (RR) with 95% confidence intervals (CI). Heterogeneity was assessed by the Q test and I 2 test. Results. The final meta-analysis included 1829 patients in 13 RCTs. Compared with the placebo or no treatment group, prophylactic antibiotics could significantly reduce the risk of bacteriuria ( RR = 0.42 , 95% CI: 0.30-0.60) and the risk of symptomatic UTI ( RR = 0.65 , 95% CI: 0.48-0.88). In addition, there was no statistically significant difference in the risk of adverse events ( RR = 4.93 , 95% CI: 0.61-40.05). No significant heterogeneity or publication bias was found in this study. Conclusions. Current evidence showed that prophylactic antibiotics could reduce the risk of asymptomatic bacteriuria and symptomatic UTI after UDS without increasing the incidence of adverse events.

The impact of the coronavirus disease 2019 pandemic on changes in antimicrobial prophylaxis and development of genito‐urinary tract infections after urodynamic study: A retrospective comparative study of a single rehabilitation hospital in Japan

“…Meanwhile, the incidence of GUTI after UDS was 4.2% and 4.7%, respectively, and the GUTI‐free rate within 7 days after UDS was found the equivalence. A meta‐analysis 5 of the efficacy of AP on GUTI (or UTI) after UDS showed that there was a significant difference between with and without AP. On the other hand, there are several studies 2 , 3 , 17 that show no significant differences of the frequency of subsequent UTI development between with and without AP, but the equivalence of incidence has not been verified.…”

“…For the sample size, our previous data 13 showed that the GUTI‐free rate within 7 days after UDS was about 96%, and if we assume that this rate does not change before and after the appearance of COVID‐19, the sample size that satisfies a 80% detection power with an alpha error of 5% would be about 168 cases in each group with 1:1 allocation, for a total of 336 cases, and we designed the patient population to meet this requirement. The equivalence margin was set at 6%, which is corresponding to a half of the lower limit of the confidence interval, based on the results of the meta‐analysis 5 …”

“…The equivalence margin was set at 6%, which is corresponding to a half of the lower limit of the confidence interval, based on the results of the meta‐analysis. 5 …”

Recurrent Urinary Tract Infections and Asymptomatic Bacteriuria in Adults

“…Most societies recommend against treating it, as many studies have not found any benefit from antibiotics [ 119 ]. Nevertheless, a recent meta-analysis found a higher rate of symptomatic UTI in patients with previous AB who did not receive antibiotic prophylaxis (RR = 0.65, 95% CI: 0.48–0.88) [ 120 ]. However, they did not analyse more severe complications (sepsis, hospitalization, and death).…”

A Retrospective Cohort Study to Identify the Risk Factors for Urinary Tract Infection After Office Procedures

“…Although risk factors for UTI after UDS were identified in the latter 2 studies, both authors report low incidence of UTI after UDS and recommend against antibiotic prophylaxis. In 2021, Wu et al 8 also performed a meta-analysis, which included studies in both male and female patients in which the authors concluded that the use of antibiotic prophylaxis reduced the incidence of both bacteriuria and UTI after UDS. This is in contrast to the UDS guidelines, which recommend against antibiotic prophylaxis except for high-risk patients.…”