Symptomatic Urinary Tract Infection After Urodynamics: A Retrospective Cohort Analysis of 250 Consecutive Patients in the Absence of Antimicrobial Prophylaxis

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Neurourology and Urodynamics


Introduction:The use of antibiotic prophylaxis forurodynamic testing (UDS) is historically based on a paucityof outcomes data. The current best practice policy statementencourages prophylaxis in non‐index patients. However,with the burden of antimicrobial resistance, there is valuein critically assessing the necessity of such prophylaxis, inorder to optimize antimicrobial stewardship.Methods:A retrospective cohort review of all patientsundergoing UDS was conducted at a single institutionbetween May 2017 and July 2018. Inclusion criteria was asfollows: no antimicrobials within seven days, for dailyprophylaxis, or post‐procedure; and documented follow‐upwithin three months. The analysis was stratified by age, BMI,medical comorbidities, neurologic disease, immunosuppres-sion, bladder management, history of orthopedic implants,and post void residual/bladder outlet obstruction. Index andnon‐index were compared, quantifying incidence of sympto-matic urinary tract infections (UTI) within 30 days.Results:Two hundred fifty patients qualified foranalysis. Twelve (4.80%) patients total developed sympto-maticUTI.Mediantimetoinfectionwas8days.Nopatientdeveloped pyelonephritis or sepsis. There were 123 (49.2%)index patients with 5 (4.07%) UTIs, and 127 (50.8%)non‐index patients with 7 (5.51%) UTIs. The non‐indexcohort (defined by the 2017 best practice policy statement),included the following patient sub‐groups and rates ofinfection, respectively: age greater than 70 years old (n = 84;UTI 3.57%); neurogenics (n = 36; UTI 11.11%) sub classifiedas multiple sclerosis (n = 17; UTI 17.65%), Parkinson’sdisease, (N = 6; 16.67%), CVA (N = 12; no UTI) , and spinalcord injury (N = 1; no UTI); orthopedic implants (N = 17;no UTI); post void residual greater than 100 (N = 42; UTI 7.14%); bladder outlet obstruction (N = 27; UTI 7.41%);immunosuppression (N = 30; UTI 10.0%) [chemotherapy,chronic steroids, transplant, innate deficiency]; indwellingFoley or suprapubic tube (N = 9; no UTI); and intermittentcatheterization (N = 3; 1.20%, no UTI).Conclusion:This data demonstrates an acceptably lowinfection rate, by any standard, even in non‐index patients.The highest rates of symptomatic UTI occurred in themultiple sclerosis and Parkinson’s disease sub‐group.Nonetheless, not one patient developed sepsis or any moresevere morbidity. This analysis provides concrete patientoutcomes as a basis for shifting treatment paradigms;calling into questions the utility of antibiotic prophylaxiseven in the non‐index patient undergoing UDS.