Validation of the best practice policy statement on urodynamic antibiotic prophylaxis for the high-risk patient in the era of antibiotic stewardship

Aims: To validate the recommendations of the Society of Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction (SUFU) 2017 Best Practice Policy Statement (BPPS) for Urodynamic Antimicrobial Prophylaxis in high-risk patients. Methods: After institutional review board approval, 489 patients who underwent urodynamics (UDS) in the absence of antibiotic prophylaxis were retrospectively reviewed. Patients were stratified according to the SUFU BPPS risk factors (neurogenic lower urinary tract dysfunction [NLUTD], elevated postvoid residual [PVR], immunosuppression, age over 70, catheter use, and orthopedic implants). χ², Fisher's exact test, Student t test, and univariate and multiple logistic regression analyses were used to assess the associations between these risk factors and postprocedural urinary tract infection (UTI). Results: Twenty-two (4.5%) patients developed symptomatic postprocedural UTI. Univariate analysis revealed statistical differences in the incidence of UTI in patients with elevated PVR and NLUTD groups. The variables that were associated with UTI on multivariate analysis were elevated PVR (odds ratio [OR]: 4.91, 95% confidence interval [CI], 1.92-12.56, P =.001) and NLUTD (OR: 4.84, 95% CI, 1.75-3.37, P =.002). The data analysis for all other high-risk groups failed to show significant correlations with UTI on univariate or multivariate analysis. Patients with three risk factors were more likely to develop UTI than patients with 1 or 2 risk factors. No patient developed pyelonephritis, sepsis, or joint infection. Conclusions: Elevated PVR, NLUTD, and possessing three risk factors were significant predictors for post-UDS UTI. All other risk factors were not associated with postprocedural UTI. Morbidity associated with UTI was low. Antimicrobial prophylaxis for these conditions should be reconsidered.