A. Moradzadeh

What is the ideal antibiotic prophylaxis for intravesically administered Botox injection? A comparison of two different regimens

IntroductionOnabotulinum toxin A (Botox®) administered intravescially is an effective treatment for idiopathic detrusor overactivity, of which urinary tract infections (UTIs) are a common complication. The purpose of this study was to compare two prophylactic antibiotic regimens with the goal of decreasing UTI rates following intravesically administered Botox® injection.Materials and methodsA retrospective review of two groups of patients undergoing intravesically administered Botox® injections was performed—one with idiopathic and one with neurogenic detrusor overactivity. One group received a dose of ceftriaxone intramuscularly (IM) at the time of Botox® injection, and a second group received a 3-day course of a fluoroquinolone orally starting the day before the procedure. The rate of postprocedure UTI was examined using a χ2 test. A secondary analysis was performed using logistic regression modeling to test the association between clinical characteristics and antibiotic regimen and risk of postprocedure UTIs.ResultsBotox® injections were performed on 284 patients: 236 received a single dose of ceftriaxone IM and 48 received 3 days of a fluoroquinolone orally. The UTI rate was significantly lower in the fluoroquinolone group (20.8%) vs. the cephalosporin group (36%), p = 0.04. Predictors of postprocedure UTIs included single dose of antibiotics IM [odds ratio (OR 2.80, p = 0.02] and a positive preprocedure urine culture (OR 1.31, p = 0.03).ConclusionsWe found a significantly lower rate of UTIs when patients received a 3-day course of a fluoroquinolone orally as opposed to a single dose of a third-generation cephalosporin IM. Patients with a positive preprocedure culture might benefit from an even longer duration of antibiotics at the time of Botox® injection.

PD54-08 WHAT IS THE IDEAL ANTIBIOTIC PROPHYLAXIS FOR INTRAVESICAL BOTOX INJECTION? A COMPARISON OF TWO DIFFERENT REGIMENS

were assessed at 4,12 and 24 weeks after injection. Treatment consisted of 30 injections distribuited into the detrusor muscle, avoiding trigone. The primary outcome was change in clinical status, including urinary frequency, urgency and urinary urgency incontinence (UUI) episodes. Secondary outcomes were changes in maximum cystometric capacity (MCC), volume at first desire to void (FDV) and post-void residual (PVR). Quality of life (QoL) was assessed using a visual analogue scale (VAS,0-10) and a patient global impression of improvement (PGI-I).Urinary retention, urinary tract infection (UTI) and required clean intermitent catheterization (CIC) were adverse events. RESULTS: A total of 22 patients were randomized to either 300U (n1⁄411) or 500U (n1⁄411) groups. Baseline demographics characteristics were comparable for both groups. All 21 patients reported urgency, with 90% of UUI before treatment. At 12 w, an important reduction in daily UUI episodes was observed in two groups, with 90% of them being dry. Decrease in mean episodes of nocturia and urinary frequency, increase FDV and CCM and a mean reduction in total ICIQOAB were observed. At 24 w, episodes of UUI had returned in 50% (300U) and 0% (500U) (p1⁄40,013). Patients had an impression of significant improvement in 70% (300U) and 88,9% (500U) at 12w; and 50% (300U) and 100% (500U),at 24w. Score of VAS was manteined higher in 500U group. There was a significant increase in mean PVR after treatment (4w) in both groups. Our incidence of UTI was 36,7% (300U) and 34,6% (500U). One patient (500U) required CIC for 2 weeks. CONCLUSIONS: Data from this study suggest 500U improves symptoms and quality of life for longer time than 300U. However, results are not significantly differents to determine which dose is safer. As far we know this is the first study to compare two doses of AbobotulinumtoxinA for refractory idiophatic OAB.

THE RISK OF CLOSTRIDIUM DIFFICILE IN HEART TRANSPLANT PATIENTS ON DIFFERENT IMMUNOSUPPRESSION REGIMENS

Background: Clostridium Difficile is a common complication after heart transplant (ht tx) especially in those patients (pts) receiving prophylactic antibiotics. It has not been demonstrated if a specific immunosuppression regimen leads to more development of C.Difficile after ht tx. Therefore, we evaluated our ht tx pts and divided them into pts who were on induction therapy vs no induction and further divided those into TAC/MMF vs CSA/MMF.