Hypothesis / aims of study
Prophylactic antibiotherapy before urodynamic examination (UDE) in case of asymptomatic bacteriuria remains controversial (1,2). In the context of the worldwide rise of bacterial resistance triggered by unnecessary antibiotherapies, it seems pivotal to avoid their use as much as possible. In this prospective study, we aimed at comparing the incidences of urinary tract infection (UTI) within one week after UDE between two groups of patients. In the first group (group A), the patients with asymptomatic bacteriuria one week before UDE were treated according to antibiogram prior UD. In the second group (group B), none of the patients were treated for asymptomatic bacteriuria.
Study design, materials and methods
Inclusion criterium was a neuro-urology visit with UDE. Exclusion criteria were cancellation of the UDE (refusal of patient or ongoing UTI), or performance of Botox® injections on the same visit. In all patients, a catheterized urine sample was acquired just before urodynamic examination for bacterial culture. Patients were then contacted per phone call seven days after UDE and asked whether they had presented in the past week one of the following symptoms: turbid and foul smelling urine, discomfort or pain at kidney or bladder level while voiding, unusual urinary incontinence, fever, spasticity, autonomous hyperreflexia, fainting, lethargy or unwell being. Symptomatic patients were treated according to antibiogram of a new urine culture.
In total 156 patients were screened out of which 151 were included among which 46 belonged to group A and 105 to group B. Both groups were comparable in terms of gender, age, neurogenic bladder rate and voiding mode. Patients with asymptomatic bacteriuria on the day of UDE reached 22,0 % in group A and 29,5% in group B. After one week, 15 patients could not be reached per phone call (5 in group A and 10 in group B) and 3 patients presented with UTI symptoms, while no patient presented fever. Among them, 2 patients (one in each group) had a urine-culture proven UTI both with a non-neurogenic bladder. UTI incidences after UDE reached 2,44% and 1,05% in groups A and B respectively.
Interpretation of results
Although the prevalence of asymptomatic bacteriuria was high among patients scheduled for UDE, UTI incidence after UDE was lower than 1,5% and no febrile UTI arose. Furthermore, prophylactic antibiotherapy in case of asymptomatic bacteriuria did not reduce UTI incidence after UDE.