Journal article
Urinary tract infection and drug-resistant urinary tract infection after intradetrusor onabotulinumtoxinA injection versus sacral neuromodulation
International urogynecology journal, Vol.31(5), pp.871-879
05/2020
DOI: 10.1007/s00192-019-04007-7
PMCID: PMC6980323
PMID: 31222571
Abstract
Intradetrusor onabotulinumtoxinA (BTX) and sacral neuromodulation (SNM) are effective treatments for refractory urgency urinary incontinence/overactive bladder (UUI/OAB). BTX carries a risk of urinary tract infection (UTI), which is concerning for the development of multidrug resistant (MDR) UTI. We hypothesized that BTX might carry a higher risk of UTI and MDR UTI compared with SNM and that UTI and MDR UTI risk might increase after repeat BTX injection. This retrospective cohort study included women undergoing BTX or SNM for refractory UUI/OAB in 2012-2016. UTI and MDR UTI were assessed up to 1 year post-treatment or until repeat treatment and compared between initial BTX and SNM and between repeat BTX injections. Univariate analyses included Chi-squared and Fisher's exact tests and generalized linear models (GLM) with logit link function. Multivariate analyses used GLM to assess the best predictor variables for any UTI. One hundred and one patients were included (28 BTX, 73 SNM). Rates of UTI (39.3% [95% CI 21.5, 59.4] BTX vs 37.0% [95% CI 26.0, 49.1] SNM) were similar in the two groups at all time intervals. One MDR UTI occurred after SNM. Risk of UTI did not increase with repeat BTX (11 out of 28 [39.3%], 6 out of 17 [35.3%], and 4 out of 7 [57.1%] after 1, 2, and ≥ 3 treatments respectively; p = 0.62). Multivariate analysis found that history of recurrent UTI (OR 2.5, 95%CI 0.98-6.39) and prolapse repair (OR 4.6, 95%CI 1.23-17.07) had increased odds of UTI. Rates of UTI were similar in patients undergoing BTX and SNM. MDR UTI was rare. Patients with prior prolapse repair or recurrent UTI may be at a higher risk of UTI after either procedure.
Details
- Title: Subtitle
- Urinary tract infection and drug-resistant urinary tract infection after intradetrusor onabotulinumtoxinA injection versus sacral neuromodulation
- Creators
- Caroline G Elmer-Lyon - Department of Obstetrics and Gynecology, Division of Urogynecology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA. caroline-elmer@uiowa.eduJudy A Streit - Department of Internal Medicine, Division of Infectious Disease, University of Iowa Hospitals and Clinics, Iowa City, IA, USAElizabeth B Takacs - Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, IA, USAPatrick P Ten Eyck - Institute for Clinical and Translational Research, University of Iowa Hospitals and Clinics, Iowa City, IA, USACatherine S Bradley - Department of Obstetrics and Gynecology, Division of Urogynecology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
- Resource Type
- Journal article
- Publication Details
- International urogynecology journal, Vol.31(5), pp.871-879
- DOI
- 10.1007/s00192-019-04007-7
- PMID
- 31222571
- PMCID
- PMC6980323
- NLM abbreviation
- Int Urogynecol J
- ISSN
- 0937-3462
- eISSN
- 1433-3023
- Publisher
- England
- Grant note
- UL1 TR002537 / NCATS NIH HHS
- Language
- English
- Date published
- 05/2020
- Academic Unit
- Epidemiology; Biostatistics; Obstetrics and Gynecology; Urology; Internal Medicine
- Record Identifier
- 9983931818602771
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