ANTIMICROBIAL PROPHYLAXIS BEFORE URODYNAMIC STUDY: SINGLE INSTITUTION EXPERIENCE IN A FACE OF AUA/SUFU BEST POLICY STATEMENT ON URODYNAMIC ANTIMICROBIAL PROPHYLAXIS
Urodynamic study (UDS) is an invasive ambulatory procedure that carries a risk for urinary tract infection (UTI). SUFU has published the Best practice policy statement on urodynamic antibiotic prophylaxis in the non-index patient. The statement justifies antimicrobial prophylaxis before UDS in patients with certain risk factors. However, most of the recommendations for antibiotic prophylaxis have low level of evidence. The aim of the study was to verify a symptomatic post-UDS UTI rate following local protocol of antibiotic prophylaxis and identify possible risk factors for post-UDS symptomatic UTI.
680 patients in an IRB-approved retrospective review of UDS clinic electronic charts' database. Anyone with symptoms of: dysuria, urinary frequency, urgency or fever and a positive urine culture within 7 days after UDS considered as post-UDS symptomatic UTI. Following variables: age >70, male gender, past or current smoking, diabetes mellitus, neuropathic pathologies, time interval between urine culture (UC) and a day of UDS, presence of asymptomatic bacteriuria pre-UDS were verified as possible risk factors for post-UDS UTI.
Mean age of a study population was 64.2 (range=19-95) years old. 408/680(60%) were male. 544(80%) patients had a negative UC prior to UDS with similar symptomatic UTI rate [9(1.7%) vs 2(1.5%)] among patients who had prior to UDS appropriately treated positive UC (p=1.0). There was no significant difference in a time interval between UC and a date of UDS in a group that developed UTI compared to an asymptomatic group (p=0.48). In both, univariate and multivariate analysis, age >70, time interval between UC and UDS more than a week, male gender, diabetes mellitus and neuropathic conditions were found as a non-significant variables predicting post-UDS symptomatic UTI
The first study to verify a symptomatic post-UDS UTI rate and identify possible risk factors for post-UDS symptomatic UTI. This study supports our antimicrobial prophylaxis protocol before UDS to minimize post-UDS UTI rate. However, a retrospective design and a relatively small number of patients in each group of proposed risk factors might cause that only few risk factors were with significance were found in a multivariate analysis.