Risk of urinary tract infection after detrusor botulinum toxin A injections for refractory neurogenic detrusor overactivity in patients with no antibiotic treatment.
OBJECTIVE
To determine if antibiotic prophylaxis is required for intradetrusor botulinum toxin A (BoNT-A) injections.


METHODS
This was a prospective non-randomized study. Inclusion criteria were adult patients with neurogenic detrusor overactivity who failed anticholinergic-based first-line treatment and had sterile urine culture 7 days before injections, a negative dipstick test on the day of the injections, and were performing clean intermittent self-catheterization. Injections were performed using a rigid cystoscope, under local anaesthetic. Patients received BoNT-A as either Botox® (Allergan Inc., Irvine, CA, USA) 300 U in 30 sites or Dysport® (Ipsen Ltd, Ipsen, Paris, France) 750 U in 20 sites. Urine culture was done 6 days and 6 weeks after the injections. If urinary tract infection (UTI) was suspected, a physician performed a complete physical examination. The primary outcome criterion was the occurrence of UTI during the first week after injections.


RESULTS
In all, 42 patients (22 women, 20 men) with a mean (sd) age 45.3 (16.4) years were included. A symptomatic UTI occurred during the first week after the injections in three patients (7.1%). The urinary colonization rate was 31% and 26% at 6 days and 6 weeks after injection, respectively. The most common bacterium was Escherichia coli (62.5%). There were no differences between 20 and 30 injection sites or between the sexes.


CONCLUSIONS
The rate of UTI after intradetrusor injections of BoNT-A was 7.1%. The most frequent bacterium involved was Escherichia coli. These results indicate that antibiotic prophylaxis for intradetrusor BoNT-A injections seems necessary.
Mouttalib
Sofia
S
Service d'Urologie, Transplantation Rénale et Andrologie Service de Médecine Physique et Réadaptation, CHU Rangueil, Toulouse, France.
Khan
Shahid
S
Castel-Lacanal
Evelyne
E
Guillotreau
Julien
J
De Boissezon
Xavier
X
Malavaud
Bernard
B
Marque
Philippe
P
Rischmann
Pascal
P
Gamé
Xavier
X
D000328:Adult; D019072:Antibiotic Prophylaxis; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D012008:Recurrence; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy*; D053201:Urinary Bladder, Overactive / Q000188:drug therapy*; D014552:Urinary Tract Infections / Q000517:prevention & control*
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A