Antibiotic Use for Urodynamics: A Comprehensive Review that Informs Local Practice

The question is addressed of whether antibiotics should be given prophylactically to all patients undergoing urodynamic testing or targeted only to those considered at higher risk for urinary tract infection after the procedure. A PICOT (Population, Intervention, Comparison, Outcome, Time) question was formulated to ensure a successful search strategy. The clinical question aimed to address the issue of widespread use of antibiotic prophylaxis as this remains unclear in the literature.

The MEDLINE®, Embase®, Ovid, Cochrane Library and CINAHL databases were searched from January 1995 to December 2014, and all articles were reviewed and collated. A total of 30 publications were included in this analysis.

Many articles addressed the issue of antibiotic use. However, some only addressed 1 antibiotic, while others identified their primary outcome as newly acquired significant bacteriuria as opposed to urinary tract infection, with variable definitions found. Outcome measures entailed end points from 2 to 7 days. Other articles only included various subgroups of the population. It was widely accepted that urinalysis screening was best practice.

Urodynamic studies are associated with a low incidence of urinary tract infection in the general population and, therefore, do not require routine prophylaxis. Local practice audits of infection rates should guide clinical practice. This literature review has resulted in a useful baseline to undertake a review of local infection rates, and develop an evidence-based antimicrobial prophylaxis guideline that is individually targeted, and dependant on mid stream urine screening, patient risk factors and local susceptibility profiles.