Podium Session

Poster, Podium & Video Sessions

PD54-08: What is the ideal antibiotic prophylaxis for intravesical Botox injection? A comparison of two different regimens

Monday, May 15
10:40 AM - 10:50 AM
Location: BCEC: Room 159

Presentation Authors: Justin Houman*, Juzar Jamnagerwalla, Ariel Moradzadeh, Kian Asand, Devin Patel, Jennifer Anger, Karyn Eilber, Los Angeles, CA

Introduction: Intravesical onabotulinum toxin A (Botox®) is an effective treatment for idiopathic detrusor overactivity of which urinary tract infections (UTIs) are a common complication. We previously identified a UTI rate of 35.1% in patients who received a single intramuscular (IM) dose of a third-generation cephalosporin (ceftriaxone) at the time of Botox injection. Given this high rate of infection despite single-dose antibiotic prophylaxis, we changed our practice pattern to determine if a longer course of antibiotic treatment would decrease the UTI rate following intravesical Botox injection.

Methods: We retrospectively evaluated patients undergoing intravesical Botox injections from May 2012 to November 2016. All procedures were performed at the same office location. One group of patients, with negative pre-procedure urine cultures, was given an IM dose of a third-generation cephalosporin. A second group, also with negative pre-procedure cultures, received a 3-day course of an oral fluoroquinolone starting the day before Botox injection. Data abstracted included age, BMI, history of diabetes, pre/post procedure urine culture. Pre-procedure UTI was defined as asymptomatic bacteriuria. The post-procedure UTI rate was examined using a χ2 test. A secondary analysis was performed using logistic regression modeling to test the association between clinical characteristics and antibiotic regimen and risk of post-procedure UTI.

Results: 284 Botox injections were performed over the study period - 236 patients received a single IM dose of ceftriaxone and 48 patients received three days of oral ciprofloxacin. There was no difference in the baseline age, BMI, diabetes, or rate of pre-procedure positive culture between the two groups. Overall, the UTI rate was significantly lower in the fluoroquinolone group (20.8%) vs. the cephalosporin group (36%), p=0.042. On multivariable regression analysis, predictors of post-procedure UTI included single IM dose of prophylaxis (OR 2.80, 95% CI 1.2-6.5, p=0.016) and positive pre-procedure urine culture (OR 1.31, 95% CI 1.03-1.66, p=0.027). Age, BMI and diabetes were not associated with post-procedure UTI.

Conclusions: In our series comparing two different antibiotic prophylaxis regimens for Botox injection, we found a significantly lower rate of UTI when patients received a three-day course of an oral fluoroquinolone as opposed to a single IM dose of a third-generation cephalosporin. Patients with a positive pre-procedure culture may benefit from longer duration of antibiotics at the time of Botox injection.

Source Of Funding: none

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PD54-08: What is the ideal antibiotic prophylaxis for intravesical Botox injection? A comparison of two different regimens



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