Aim:
To evaluate the incidence and predictors of symptomatic urinary tract infection following urodynamic studies in neurogenic patients performing clean intermittent catheterization without antibiotic prophylaxis.

Hypothesis:
Routine antibiotic prophylaxis before urodynamic studies may not be necessary in neurogenic patients performing clean intermittent catheterization.

We conducted a prospective cohort study including consecutive patients with neurogenic lower urinary tract dysfunction performing clean intermittent catheterization who underwent urodynamic studies. No antibiotic prophylaxis was administered. Before the procedure, demographic and clinical data were collected, and urine samples for urinalysis and culture were obtained. Patients were followed for 15 days after urodynamic studies to identify symptomatic urinary tract infections. Pre-procedure variables were analyzed as potential predictors.

A total of 151 patients were included (median age 41 years, IQR 31–50; 60.3% men). The main etiologies of neurogenic lower urinary tract dysfunction were spinal cord injury (43.0%) and spina bifida (31.1%). A history of recurrent urinary tract infection was reported by 20.5% of patients, and 89.4% had a positive pre-urodynamic urine culture. Symptomatic urinary tract infection occurred in 21 patients (13.9%) within 15 days after urodynamic studies. The median time to onset was 5 days (IQR 3–7). Most infections were mild, and no cases of urosepsis were observed. Pre-urodynamic urine culture positivity was not associated with post-procedure infection (p = 0.13). A history of recurrent urinary tract infections was significantly associated with post-urodynamic infection (univariate OR 3.61, 95% CI 1.21–10.79; p = 0.001) and remained the only independent predictor on multivariable analysis (adjusted OR 3.27, 95% CI 1.05–10.19; p = 0.041).

In neurogenic patients performing clean intermittent catheterization, the incidence of symptomatic urinary tract infection after urodynamic studies was relatively low without antibiotic prophylaxis. Recurrent infection history was the only independent predictor, while routine pre-procedure urine culture did not predict outcomes.

Routine antibiotic prophylaxis before urodynamic studies may not be necessary in neurogenic patients performing clean intermittent catheterization. A risk-based approach targeting patients with a history of recurrent urinary tract infections appears more appropriate, supporting safer and more rational antibiotic use.

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