Antibiotic Prophylaxis Choice & Duration for UTI Prevention after OnabotulinumtoxinA Injections

Thursday, October 5, 2023

3:30 PM – 4:30 PM US PST

Location: B119

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Image Label: Table 1: Baseline Characteristics by Antibiotic Regimen

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Image Label: Table 2: Risk of Urinary Tract Infection by Antibiotic Regimen

Scientific Table Presenter(s)

Christopher W. Heuer (he/him/his)

Urogynecology Fellow
Walter Reed National Military Medical Center
Arlington, Virginia, United States
Christopher W. Heuer (he/him/his)

Urogynecology Fellow
Walter Reed National Military Medical Center
Arlington, Virginia, United States

Co-Author(s)

JG

Jordan D. GIsseman, MD (he/him/his)

Urogynecology Fellow
Walter Reed National Military Medical Center
Derwood, Maryland, United States
JG

Jordan D. GIsseman, MD (he/him/his)

Urogynecology Fellow
Walter Reed National Military Medical Center
Derwood, Maryland, United States
AG

Alissa C. Galgano, DO

OBGYN Resident
Walter Reed National Military Medical Center
Arlington, Virginia, United States
AG

Alissa C. Galgano, DO

OBGYN Resident
Walter Reed National Military Medical Center
Arlington, Virginia, United States
CO

Cara H. Olsen, MS DrPH

Statistician
Uniformed Services University of the Health Sciences
Bethesda, Maryland, United States
CO

Cara H. Olsen, MS DrPH

Statistician
Uniformed Services University of the Health Sciences
Bethesda, Maryland, United States
Kati Dengler, MD FACOG FPMRS FACS (she/her/hers)

Associate Professor USUHS and Chief, Urogynecology Division
Walter Reed National Military Medical Center
Bethesda, Maryland, United States
Kati Dengler, MD FACOG FPMRS FACS (she/her/hers)

Associate Professor USUHS and Chief, Urogynecology Division
Walter Reed National Military Medical Center
Bethesda, Maryland, United States
Christine M. Vaccaro, DO (she/her/hers)

Urogynecology Fellowship Director
Walter Reed National Military Medical Center
Rockville, Maryland, United States
Christine M. Vaccaro, DO (she/her/hers)

Urogynecology Fellowship Director
Walter Reed National Military Medical Center
Rockville, Maryland, United States

Disclosure(s):

Christopher W. Heuer: No financial relationships to disclose

Jordan D. GIsseman, MD: No financial relationships to disclose

Alissa C. Galgano, DO: No financial relationships to disclose

Cara H. Olsen, MS DrPH: No financial relationships to disclose

Kati Dengler, MD FACOG FPMRS FACS: No financial relationships to disclose

Christine M. Vaccaro, DO: No relevant disclosure to display

Objectives: Evaluate both the choice and duration of antibiotic prophylaxis on the incidence of urinary tract infection (UTI) within 30 days of intradetrusor onabotulinumtoxinA injections in an outpatient setting.

Methods: Single site, retrospective analysis of 305 patients with predominantly overactive bladder (OAB) symptoms or bladder pain syndrome (BPS) who received prophylactic antibiotics for in-office, 100-unit intradetrusor onabotulinumtoxinA injections from 2019-2023. The categories of antibiotic prophylaxis compared included 1) nitrofurantoin 100mg twice daily for 3 days, 2) nitrofurantoin 100mg twice daily for 5 days, 3) trimethoprim-sulfamethoxazole 160mg/800mg (DS) twice daily for 3 days and 4) “other regimens.” Our primary outcome was the incidence of urinary tract infection within 30 days of these injections. The study also investigated urinary retention rates over 4 years.

Results: Incidence of the primary outcome (diagnosis based on either culture or treatment) was 10.4% in the 3-day nitrofurantoin group, 20.5% in the 5-day nitrofurantoin group, 7.4% in the 3-day double strength trimethoprim-sulfamethoxazole group, and 25.7% among those patients receiving “other regimens” (p = .023). Those receiving 3 days of double strength trimethoprim-sulfamethoxazole had 31% lower odds of UTI within 30 days, however this difference was not statistically significant (OR = .689, p = .518). Compared with the 3-day nitrofurantoin regimen, those receiving 5 days of nitrofurantoin had greater than two times higher odds of UTI within 30 days (OR = 2.22, p = .088). Those receiving other regimens had nearly three times higher odds of UTI within 30 days (OR = 2.98, p = .018). There was a statistically significant association between the type of antibiotic and incidence of UTI within 30 days, regardless of whether diagnosis was based on culture or treatment. Adjusting for age and race did not account for the differences between regimens. Patient demographic and clinical characteristics were similar among the four regimen categories, with the exception that white patients were significantly more likely to receive an "other regimen.” The overall retention rate was 1.97%.

Conclusions: Both antibiotic choice and duration of use impact the incidence of UTIs after in-office, intradetrusor onabotulinumtoxinA injections with three-day antibiotic regimens of nitrofurantoin and trimethoprim-sulfamethoxazole double strength having the lowest incidence of UTI. Further prospective studies are warranted to determine if these findings are due to patient compliance or if the benefit of shorter duration of antibiotics would be consistent in even one day dosing.