Session: MP19: Health Services Research: Practice Patterns, Quality of Life & Shared Decision Making I
MP19-06: Antibiotic Use, Best Practice Statement Adherence, and UTI Rate for Intradetrusor Onabotulinumtoxin A Injection for Overactive Bladder: A Multi-Institutional Collaboration from the SUFU Research Network
Introduction: Onabotulinumtoxin A (BTX-A) is a well-established treatment for overactive bladder (OAB). The American Urological Association (AUA) 2008 Antibiotic Best Practice Statement recommended trimethoprim-sulfamethoxazole or fluoroquinolone for cystoscopy with manipulation. The aim of the study was to evaluate concordance with antibiotic best practices at the time of BTX-A injection and urinary tract infection (UTI) rates based on antibiotic regimen. Methods: We included men and women undergoing first-time BTX-A injection for idiopathic OAB with 100 units in 2016 within the SUFU Research Network multi-institutional retrospective database. Patients on suppressive antibiotics were excluded. The primary outcome was concordance of periprocedural antibiotic use with the AUA 2008 Best Practice Statement. As a secondary outcome we compared the incidence of UTI at 15 days and 30 days after BTX-A among women. 15 days was used as a cutoff for a UTI attributed to BTX-A injection procedure, whereas a UTI within 30 days was considered a chronic effect of BTX-A. We assumed that patients who were not seen in the first 15 days did not have a UTI within 15 days. Fisher’s exact tests were applied for categorical variables. Results: Of the cohort of 216 patients (175 women, 41 men) undergoing BTX-A, 24 different periprocedural antibiotic regimens were utilized. Among patients who had in-office visits within 15 days of BTX-A, 87% received periprocedural antibiotics and 47% received best practice statement-concordant antibiotics. There was no significant difference in UTI events between patients who received any antibiotics and those that did not at 15 day follow up (N=173, 6% vs 9%, P=0.4). Of patients who received antibiotics, UTI rates did not vary significantly depending on concordance with recommendations or not (N=133, 5% vs 7%, P=0.7). 81% of the 216 patients with 30-day follow up received periprocedural antibiotics. Of those, 47% received best practice statement-concordant antibiotics. At 30 days, there was no significant difference in UTI events based on antibiotic use (N=173, 11% antibiotics vs 16% no antibiotics, P=0.5) or best practice statement concordance or not 8% vs 16% (N=133, P=0.13). Conclusions: This retrospective multi-institutional study demonstrates that antibiotic regimens and adherence to the AUA Best Practice Statement was variable among providers and that UTI rates at 15 or 30 days following BTX-A did not vary significantly regardless of antibiotic use or alignment with best practices. SOURCE OF Funding: SUFU Research Network
