Onabotulinumtoxin 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.
Men 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).
Of 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).
This 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.
Neurourology and urodynamics. 2023 Nov 30 [Epub ahead of print]
Katherine Shapiro, Jennifer Anger, Anne P Cameron, Doreen Chung, Stephanie Daignault-Newton, Giulia M Ippolito, Una Lee, Arthur Mourtzinos, Priya Padmanabhan, Ariana L Smith, Anne M Suskind, Christopher Tenggardjaja, Monica Van Til, Benjamin M Brucker
Department of Urology, New York University, New York City, New York, USA., Department of Urology, University of California San Diego, San Diego, California, USA., Department of Urology, University of Michigan, Ann Arbor, Michigan, USA., Department of Urology, Columbia University Medical Center, New York City, New York, USA., Virginia Mason Medical Center, Seattle, Washington, District of Columbia, USA., Department of Urology, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA., Department of Urology, William Beaumont University Hospital, Royal Oak, Michigan, USA., University of Pennsylvania, Philadelphia, Pennsylvania, USA., Department of Urology, University of California San Francisco, San Francisco, California, USA., Kaiser Permanente Los Angeles Medical Center, Los Angeles, Los Angeles, California, USA.