Abstract: PD54-08
Sources of Funding: none

Introduction

Intravesical onabotulinum toxin A (Botox®) is an effective treatment for idiopathic detrusor overactivity of which urinary tract infections (UTIs) are a common complication. We previously identified a UTI rate of 35.1% in patients who received a single intramuscular (IM) dose of a third-generation cephalosporin (ceftriaxone) at the time of Botox injection. Given this high rate of infection despite single-dose antibiotic prophylaxis, we changed our practice pattern to determine if a longer course of antibiotic treatment would decrease the UTI rate following intravesical Botox injection.

Methods

We retrospectively evaluated patients undergoing intravesical Botox injections from May 2012 to November 2016. All procedures were performed at the same office location. One group of patients, with negative pre-procedure urine cultures, was given an IM dose of a third-generation cephalosporin. A second group, also with negative pre-procedure cultures, received a 3-day course of an oral fluoroquinolone starting the day before Botox injection. Data abstracted included age, BMI, history of diabetes, pre/post procedure urine culture. Pre-procedure UTI was defined as asymptomatic bacteriuria. The post-procedure UTI rate 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 post-procedure UTI.

Results

284 Botox injections were performed over the study period - 236 patients received a single IM dose of ceftriaxone and 48 patients received three days of oral ciprofloxacin. There was no difference in the baseline age, BMI, diabetes, or rate of pre-procedure positive culture between the two groups. Overall, the UTI rate was significantly lower in the fluoroquinolone group (20.8%) vs. the cephalosporin group (36%), p=0.042. On multivariable regression analysis, predictors of post-procedure UTI included single IM dose of prophylaxis (OR 2.80, 95% CI 1.2-6.5, p=0.016) and positive pre-procedure urine culture (OR 1.31, 95% CI 1.03-1.66, p=0.027). Age, BMI and diabetes were not associated with post-procedure UTI.

Conclusions

In our series comparing two different antibiotic prophylaxis regimens for Botox injection, we found a significantly lower rate of UTI when patients received a three-day course of an oral fluoroquinolone as opposed to a single IM dose of a third-generation cephalosporin. Patients with a positive pre-procedure culture may benefit from longer duration of antibiotics at the time of Botox injection.

Funding

none