Presentation Authors: Cristina Fox*, Valhalla, NY, Brian Kim, Ali Omar, Michelle Kim, Debra Fromer, Hackensack , NJ
Introduction: The Society of Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction (SUFU) and American Urological Association (AUA) support a 2017 Best Practice Policy Statement for Urodynamic (UDS) Antimicrobial Prophylaxis; advising prophylaxis of non-index high-risk patients undergoing UDS. This includes neurogenic urinary dysfunction, elevated post void residual (PVR), age greater than 70, immunosuppression, chronic catheter, and orthopedic implants. Previous prophylaxis patterns are based on a paucity of high-level evidence. This study aims to validate these guidelines with emphasis on high-risk groups.
Methods: 1100 patients underwent UDS between May 2015 and July 2018. Reviewed in this retrospective IRB-approved single institution study; exclusion criteria included: antimicrobials within seven days (including suppression), peri-procedure prophylaxis, and lack of follow-up at 90 days. 489 met criteria for analysis. Video UDS was performed with an 8 French cystometrogram catheter, rectal balloon, and patch electrodes. Urinalysis was performed prior to UDS; pyuric specimens were cultured, and pathogenic organisms treated. Chi-square, Fisher's Exact test, and t-test were used for univariate and multivariate regression analyses to assess associations between high-risk patients and urinary tract infection (UTI), controlling for confounders.
Results: Twenty-two (4.5%) patients developed symptomatic UTI within 30 days. No patient required hospitalization for sepsis or pyelonephritis. No orthopedic implants became infected. Non-index high risk groups are stratified; and univariate results are detailed in Table 1. Multivariate analysis, further supported that UTI was associated with PVR > 100 (odds ratio (OR): 4.91, 95% confidence interval (CI): 1.92 - 12.56, p=0.0009) and neurogenic urinary dysfunction (OR: 4.84, 95% CI: 1.75 - 13.37, p=0.002). Other high-risk groups failed to show a statistically significant correlation to UTI.
Conclusions: In the absence of prophylaxis, both index and non-index patients demonstrated low rates of infection. Even in the two statistically significant risk groups for UTI; no case of sepsis or significant morbidity was documented. Therefore, antimicrobial prophylaxis for UDS is not validated by this data set.