Does a recent urinary tract infection increase the risk of postprocedure urinary tract infection after onabotulinum toxin a?

Onabotulinum toxin A (BTX-A) is commonly used as treatment for refractory overactive bladder (OAB) but is associated with postprocedural urinary tract infection (UTI) in up to 35% of cases despite antibiotic prophylaxis. In women with recent UTI, it is unclear whether there should be a prolonged waiting period prior to BTX-A. Although preoperative UTI is a known risk factor for postoperative UTI following open and laparoscopic urologic procedures, it is currently unknown whether recent UTI is associated with postprocedural UTI following BTX-A. This retrospective cohort study aimed to determine whether recent UTI prior to BTX-A injection increases risk of postprocedural UTI. Adult women undergoing their first BTX-A between January 2010 and July 2016 for idiopathic or neurogenic OAB regardless of dosage were eligible. Participants were considered to have a recent UTI if they received a positive urine culture or received antibiotic therapy for urinary tract symptoms within 30 days of BTX-A. The primary study outcome was postprocedural UTI defined either with symptoms of UTI and positive urine culture/analysis or empiric treatment for UTI symptoms within 90 days of BTX-A. Antibiotic prophylaxis was prescribed before and or after injection according to physician preference or study protocol if subjects were participating in a clinical trial. Variables between the recent UTI and no recent UTI groups were compared using Wilcoxon rank sum, Fisher exact, or χ2 tests. The final cohort for analysis included 166 subjects with a median age of 66 years (range, 55-73 years). A total of 25 participants (15%) qualified as having recent UTI, and 141 (87%) as not having recent UTI. The mean time from recent UTI diagnosis to BTX-A injection was 6 days. History of recurrent UTI, prophylactic antibiotics, catheterization at baseline, urinary retention requiring catheterization following BTX-A, and neurogenic OAB were all more likely among the recent UTI cohort. A total of 49 participants (29.5%) experienced a postprocedural UTI. Women with recent UTI were more likely to have a postprocedural UTI than those without recent UTI (13/25 [52%] vs 36/141 [26%], P < 0.01). However, following logistic regression controlling for age, history of recurrent UTI, history of diabetes mellitus, prophylactic antibiotics, and urinary retention requiring catheterization following injection, the association between recent UTI and postprocedural UTI was no longer statistically significant (adjusted odds ratio, 1.98; 95% confidence interval, 0.60-6.50; P = 0.26). This retrospective cohort study in women receiving their first BTX-A injection revealed that UTI within 30 days of injection did not increase risk of postprocedural UTI when controlling for potentially confounding variables. This finding suggests that BTX-A treatment for refractory OAB need not be delayed in the context of a recent UTI.

Duke Scholars

Author Cindy Louise Amundsen Obstetrics and Gynecology, Urogynecology

Author Anthony Gabriele Visco Obstetrics and Gynecology, Urogynecology

Author Tracy Truong  

Author Yi-Ju Li Biostatistics & Bioinformatics, Division of Integrative Geno ...

Author Nazema Yusuf Siddiqui Obstetrics and Gynecology, Urogynecology