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Risk of urinary tract infection after detrusor botulinum toxin A injections for refractory neurogenic detrusor overactivity in patients with no antibiotic treatment
Author(s) -
Mouttalib Sofia,
Khan Shahid,
CastelLacanal Evelyne,
Guillotreau Julien,
De Boissezon Xavier,
Malavaud Bernard,
Marque Philippe,
Rischmann Pascal,
Gamé Xavier
Publication year - 2010
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2010.09435.x
Subject(s) - medicine , urinary system , botulinum toxin , refractory (planetary science) , antibiotics , anticholinergic , urine , urology , nitrofurantoin , anesthesia , ciprofloxacin , physics , astrobiology , microbiology and biotechnology , biology
Study Type – Harm/Safety (case series)
Level of Evidence 4 OBJECTIVE To determine if antibiotic prophylaxis is required for intradetrusor botulinum toxin A (BoNT‐A) injections. PATIENTS AND METHODS This was a prospective non‐randomized study. Inclusion criteria were adult patients with neurogenic detrusor overactivity who failed anticholinergic‐based first‐line treatment and had sterile urine culture 7 days before injections, a negative dipstick test on the day of the injections, and were performing clean intermittent self‐catheterization. Injections were performed using a rigid cystoscope, under local anaesthetic. Patients received BoNT‐A as either Botox® (Allergan Inc., Irvine, CA, USA) 300 U in 30 sites or Dysport® (Ipsen Ltd, Ipsen, Paris, France) 750 U in 20 sites. Urine culture was done 6 days and 6 weeks after the injections. If urinary tract infection (UTI) was suspected, a physician performed a complete physical examination. The primary outcome criterion was the occurrence of UTI during the first week after injections. RESULTS In all, 42 patients (22 women, 20 men) with a mean ( sd ) age 45.3 (16.4) years were included. A symptomatic UTI occurred during the first week after the injections in three patients (7.1%). The urinary colonization rate was 31% and 26% at 6 days and 6 weeks after injection, respectively. The most common bacterium was Escherichia coli (62.5%). There were no differences between 20 and 30 injection sites or between the sexes. CONCLUSION The rate of UTI after intradetrusor injections of BoNT‐A was 7.1%. The most frequent bacterium involved was Escherichia coli . These results indicate that antibiotic prophylaxis for intradetrusor BoNT‐A injections seems necessary.