Urinary tract infection in patients with spinal cord injury after urodynamics under fosfomycin prophylaxis: a retrospective analysis

Abstract

Background: Urinary tract infection (UTI) is a common complication of spinal cord injury (SCI). Urodynamic testing is widely used for characterization of vesico-sphincteric dysfunction and for therapeutic orientation. As an invasive procedure, the risk of UTI is increased so, in some medical centers, antibiotic prophylaxis is instituted. Fosfomycin is one of the antibiotics used. Objective: The aim of this study was to evaluate the incidence of UTI after urodynamics in patients with SCI, under fosfomycin prophylaxis. Methods: Retrospective analysis was performed on patients with SCI, admitted to a rehabilitation center between January 2016 and June 2017, who underwent urodynamics studies under fosfomycin prophylaxis. Demographic data, risk factors for UTI—bacteriuria before urodynamics, high residual volume (>100 mL), bladder emptying method, vesico-sphincteric dyssynergia, and detrusor hyperactivity were analyzed. The incidence of UTI after urodynamics was evaluated. Results: The study included 84 patients, predominantly men 55 (65.5%). The mean age of the patients was 55.6 (18.9). Eleven (22.5%) had vesico-sphincteric dyssynergia, 32 (65.3%) detrusor hyperactivity and 22 (44.9%) had a high residual volume. Thirty-seven (44.1%) had asymptomatic bacteriuria before the urodynamics. Urinary complaints suggestive of UTI after urodynamics were observed in 2(2.4%) of patients, without significant bacteriuria and identification of bacterial agent. Conclusions: The incidence of UTI after invasive procedures is reported between 3% and 20% in the literature, so antibiotic prophylaxis has been instituted, although controversial. In the study, in none of the patients the diagnosis of UTI was confirmed. Fosfomycin prophylaxis may have been important in reducing the incidence of UTI.

Should We Delay Urodynamic Study When Patients With Spinal Cord Injury Have Asymptomatic Pyuria?

“…Because there are many SCI cases with asymptomatic pyuria and bacteriuria unrelated to UTI, clinicians often face a difficult choice on whether they should delay UDS in cases of pre-UDS pyuria or bacteriuria. In a retrospective study of 84 patients with SCI [ 13 ], 44.1% showed asymptomatic pre-UDS bacteriuria. Likewise, in our study, pre-UDS pyuria and bacteriuria were found in 209/399 (52.4%) and 257/399 (64.4%) patients, respectively.…”