Antibiotic prophylaxis may not be necessary in patients with asymptomatic bacteriuria undergoing intradetrusor onabotulinumtoxinA injections for neurogenic detrusor overactivity

Lorenz Leitner, Ulla Sammer, Matthias Walter, Stephanie C Knüpfer, Marc P Schneider, Burkhardt Seifert, Jure Tornic, Ulrich Mehnert, Thomas M Kessler, Lorenz Leitner, Ulla Sammer, Matthias Walter, Stephanie C Knüpfer, Marc P Schneider, Burkhardt Seifert, Jure Tornic, Ulrich Mehnert, Thomas M Kessler

Abstract

Many of the patients undergoing intradetrusor onabotulinumtoxinA injections for refractory neurogenic detrusor overactivity (NDO) present with chronic bacteriuria. In these patients, antibiotic prophylaxis has been widely recommended since bacteriuria might impair treatment efficacy and cause urinary tract infections (UTI) but the evidence is limited. The aim of this study was to evaluate if an antibiotic prophylaxis is needed in patients with asymptomatic bacteriuria undergoing intradetrusor onabotulinumtoxinA injections. Between 06/2012 and 12/2014, a consecutive series of 154 patients undergoing a total of 273 treatment cycles were prospectively evaluated. Before treatment urine samples were collected, patients with no clinical signs for UTI underwent onabotulinumtoxinA injections, no antibiotic prophylaxis was given. Asymptomatic bacteriuria was found in 73% (200/273 treatments). Following treatment, UTI occurred in 5% (9/200) and 7% (5/73) of patients with and without bacteriuria, respectively. Intradetrusor onabotulinumtoxinA injections were clinically and urodynamically successful in 70% (192/273). There was no association between bacteriuria and treatment-related adverse events (odds ratio 0.64, 95% CI 0.23-1.81, p = 0.4) nor between bacteriuria and therapy failure (odds ratio 0.78, 95% CI 0.43-1.43, p = 0.4). Thus, we conclude that antibiotic prophylaxis needs to be critically reconsidered in patients undergoing intradetrusor onabotulinumtoxinA injections, especially taking into account the alarming antibiotic resistance worldwide.

Figures

Figure 1. Distribution of bacterial strains.
Figure 1. Distribution of bacterial strains.
Asymptomatic bacteriuria was found in 73% (200/273 treatments). A total of 344 microorganisms and 28 different species could be isolated, including 27 different bacterial strains as well as one fungal strain (Candida albicans). Other bacterial species included (listed according to frequency): Enterobacteriaceae cloacae, Pseudomonas aeruginosa, Staphylococcus agalactiae, Proteus vulgaris, Streptococcus milleri, Serratia marcescens, Streptococcus mitis, Corynebacterium spp., Klebsiella oxytoca, Candida albicans, Streptococcus viridans, Providencia stuartii, Citrobacter freundii, Enterobacter aerogenes, Aerococcus schaalii, Morganella morganii, Stenotrophomonas maltophilia and Staphylococcus lugdunensis.

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