Is antibiotic prophylaxis necessary for intravesical injection of botulinum toxin in women with detrusor overactivity?

Introduction: There are no guidelines regarding antibiotic prophylaxis for intravesical Botulinum toxin (BoNT-A) treatment for women with detrusor overactivity, and studies investigating their role demonstrate conflicting or inconclusive results. The reported rate of urinary tract infection (UTI) following BoNt-A varies from 10–44% and the majority of these studies involve procedures with antibiotic prophylaxis. Objective: Investigate the rate of UTI following intravesical BoNT-A without antibiotic prophylaxis, and the correlation between preceding and post-treatment UTI. Methods: Retrospective cohort study of women undergoing outpatient intravesical BoNT-A for detrusor overactivity in a district general hospital between 2020 and 2023, identifying 97 treatment episodes. Patients were screened pre-procedure to exclude infection via urine culture and the majority (92%) treated with 100 units BoNT-A. Data was collected from electronic and paper medical records. Results: The overall risk of UTI was 6.2% (6/97) at 6 weeks and 20% (19/97) at 6 months, as denoted by a positive urine culture in symptomatic patients. The risk of UTI in patients with no preceding UTI history (12 months prior to treatment) was 2.8% (2/71) at 6 weeks compared to 15.4% (4/26) patients with any previous UTI history (relative risk 5.46; p = 0.04). Those with recurrent UTI experienced the greatest risk of post-BoNT-A UTI (50%; 3/6) compared to those without UTI history (16.9%, 12/59) over 6 months (relative risk 2.95; p = 0.02). Conclusion: Intravesical BoNT-A treatment without antibiotic prophylaxis does not lead to a greater risk of developing UTI. Previous UTI is a risk factor for developing post-BoNT-A UTI.

Citation

Lee J., Umali A., Blanchard M. & Rahmanou P. (2024). Is antibiotic prophylaxis necessary for intravesical injection of botulinum toxin in women with detrusor overactivity?. BJOG: An International Journal of Obstetrics and Gynaecology, 131(1), 28. https://doi.org/10.1111/1471-0528.17881

DOI

10.1111/1471-0528.17881

URI

https://hdl.handle.net/20.500.14709/1240

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