Antibiotic prophylaxis may not be necessary in patients with asymptomatic bacteriuria undergoing intradetrusor onabotulinumtoxinA injections for neurogenic detrusor overactivity.
Many of the patients undergoing intradetrusor onabotulinumtoxinA injections for refractory neurogenic detrusor overactivity (NDO) present with chronic bacteriuria. In these patients, antibiotic prophylaxis has been widely recommended since bacteriuria might impair treatment efficacy and cause urinary tract infections (UTI) but the evidence is limited. The aim of this study was to evaluate if an antibiotic prophylaxis is needed in patients with asymptomatic bacteriuria undergoing intradetrusor onabotulinumtoxinA injections. Between 06/2012 and 12/2014, a consecutive series of 154 patients undergoing a total of 273 treatment cycles were prospectively evaluated. Before treatment urine samples were collected, patients with no clinical signs for UTI underwent onabotulinumtoxinA injections, no antibiotic prophylaxis was given. Asymptomatic bacteriuria was found in 73% (200/273 treatments). Following treatment, UTI occurred in 5% (9/200) and 7% (5/73) of patients with and without bacteriuria, respectively. Intradetrusor onabotulinumtoxinA injections were clinically and urodynamically successful in 70% (192/273). There was no association between bacteriuria and treatment-related adverse events (odds ratio 0.64, 95% CI 0.23-1.81, p = 0.4) nor between bacteriuria and therapy failure (odds ratio 0.78, 95% CI 0.43-1.43, p = 0.4). Thus, we conclude that antibiotic prophylaxis needs to be critically reconsidered in patients undergoing intradetrusor onabotulinumtoxinA injections, especially taking into account the alarming antibiotic resistance worldwide.
Neuro-Urology, Spinal Cord Injury Center &Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.|Department of Urology, University Hospital Basel, Basel, Switzerland.
Lorenz
L
Leitner
Neuro-Urology, Spinal Cord Injury Center &Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.
Ulla
U
Sammer
Neuro-Urology, Spinal Cord Injury Center &Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.
Matthias
M
Walter
Neuro-Urology, Spinal Cord Injury Center &Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.
Stephanie C
SC
Knüpfer
Neuro-Urology, Spinal Cord Injury Center &Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.|Brain Research Institute, University of Zürich and Department of Health Sciences and Technology, Swiss Federal Institute of Technology Zürich, Zürich, Switzerland.
Marc P
MP
Schneider
Epidemiology, Biostatistics and Prevention Institute, Department of Biostatistics, University of Zürich, Zürich, Switzerland.
Burkhardt
B
Seifert
Neuro-Urology, Spinal Cord Injury Center &Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.
Jure
J
Tornic
Neuro-Urology, Spinal Cord Injury Center &Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.
Ulrich
U
Mehnert
Neuro-Urology, Spinal Cord Injury Center &Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.
Thomas M
TM
Kessler
D065087:Acetylcholine Release Inhibitors / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D019072:Antibiotic Prophylaxis; D058345:Asymptomatic Infections; D001437:Bacteriuria / Q000188:drug therapy*; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D053201:Urinary Bladder, Overactive / Q000188:drug therapy*; D014554:Urination
D065087:Acetylcholine Release Inhibitors; D019274:Botulinum Toxins, Type A