Justin Houman1, Ariel Moradzadeh2, Devin N Patel2, Kian Asanad3, Jennifer T Anger2, Karyn S Eilber2. 1. Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, 8635 W. Third St., West Medical Office Tower, Suite 1070W, Los Angeles, CA, 90048, USA. Justin.houman@cshs.org. 2. Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, 8635 W. Third St., West Medical Office Tower, Suite 1070W, Los Angeles, CA, 90048, USA. 3. David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Abstract
INTRODUCTION: Onabotulinum toxin A (Botox®) administered intravescially is an effective treatment for idiopathic detrusor overactivity, of which urinary tract infections (UTIs) are a common complication. The purpose of this study was to compare two prophylactic antibiotic regimens with the goal of decreasing UTI rates following intravesically administered Botox® injection. MATERIALS AND METHODS: A retrospective review of two groups of patients undergoing intravesically administered Botox® injections was performed-one with idiopathic and one with neurogenic detrusor overactivity. One group received a dose of ceftriaxone intramuscularly (IM) at the time of Botox® injection, and a second group received a 3-day course of a fluoroquinolone orally starting the day before the procedure. The rate of postprocedure UTI was examined using a χ2 test. A secondary analysis was performed using logistic regression modeling to test the association between clinical characteristics and antibiotic regimen and risk of postprocedure UTIs. RESULTS: Botox® injections were performed on 284 patients: 236 received a single dose of ceftriaxone IM and 48 received 3 days of a fluoroquinolone orally. The UTI rate was significantly lower in the fluoroquinolone group (20.8%) vs. the cephalosporin group (36%), p = 0.04. Predictors of postprocedure UTIs included single dose of antibiotics IM [odds ratio (OR 2.80, p = 0.02] and a positive preprocedure urine culture (OR 1.31, p = 0.03). CONCLUSIONS: We found a significantly lower rate of UTIs when patients received a 3-day course of a fluoroquinolone orally as opposed to a single dose of a third-generation cephalosporin IM. Patients with a positive preprocedure culture might benefit from an even longer duration of antibiotics at the time of Botox® injection.
INTRODUCTION: Onabotulinum toxin A (Botox®) administered intravescially is an effective treatment for idiopathic detrusor overactivity, of which urinary tract infections (UTIs) are a common complication. The purpose of this study was to compare two prophylactic antibiotic regimens with the goal of decreasing UTI rates following intravesically administered Botox® injection. MATERIALS AND METHODS: A retrospective review of two groups of patients undergoing intravesically administered Botox® injections was performed-one with idiopathic and one with neurogenic detrusor overactivity. One group received a dose of ceftriaxone intramuscularly (IM) at the time of Botox® injection, and a second group received a 3-day course of a fluoroquinolone orally starting the day before the procedure. The rate of postprocedure UTI was examined using a χ2 test. A secondary analysis was performed using logistic regression modeling to test the association between clinical characteristics and antibiotic regimen and risk of postprocedure UTIs. RESULTS: Botox® injections were performed on 284 patients: 236 received a single dose of ceftriaxone IM and 48 received 3 days of a fluoroquinolone orally. The UTI rate was significantly lower in the fluoroquinolone group (20.8%) vs. the cephalosporin group (36%), p = 0.04. Predictors of postprocedure UTIs included single dose of antibiotics IM [odds ratio (OR 2.80, p = 0.02] and a positive preprocedure urine culture (OR 1.31, p = 0.03). CONCLUSIONS: We found a significantly lower rate of UTIs when patients received a 3-day course of a fluoroquinolone orally as opposed to a single dose of a third-generation cephalosporin IM. Patients with a positive preprocedure culture might benefit from an even longer duration of antibiotics at the time of Botox® injection.
Authors: Paul Abrams; Karl-Erik Andersson; Apostolos Apostolidis; Lori Birder; Donna Bliss; Linda Brubaker; Linda Cardozo; David Castro-Diaz; P R O'Connell; Alan Cottenden; Nikki Cotterill; Dirk de Ridder; Roger Dmochowski; Chantal Dumoulin; Mandy Fader; Christopher Fry; Howard Goldman; Philip Hanno; Yukio Homma; Vik Khullar; Chris Maher; Ian Milsom; Diane Newman; Rien J M Nijman; Kevin Rademakers; Dudley Robinson; Peter Rosier; Eric Rovner; Stefano Salvatore; Masayuki Takeda; Adrian Wagg; Todd Wagner; Alan Wein Journal: Neurourol Urodyn Date: 2018-08-14 Impact factor: 2.696