Antibiotic prophylaxis in urodynamics: A systematic review of secondary studies

Urodynamics is the functional study of the urinary tract and an invasive diagnostic test that involves inserting a catheter into the bladder to assess bladder-related symptoms. One major risk is the development of urinary tract infections (UTI) following the procedure. Currently, there is no global consensus on the use of antibiotic prophylaxis. This study aims to identify key recommendations regarding prophylactic antibiotic therapy associated with urodynamic procedures. A systematic review of clinical practice guidelines (CPG), systematic reviews, and meta-analyses was conducted with subsequent quality evaluation. Out of 320 references, four clinical practice guidelines, one meta-analysis, and one systematic review were selected. Three clinical practice guidelines had acceptable global quality, and one was a "Best Practice Statement". All guidelines agree that antibiotic prophylaxis is not recommended for low-risk patients but should be used in those at high risk of postoperative infection. The meta-analysis concluded that prophylactic antibiotics could reduce the risk of asymptomatic bacteriuria and symptomatic UTI post-urodynamics without increasing the incidence of adverse events. For high-risk patients, the recommended antimicrobials include trimethoprim-sulfamethoxazole or fluoroquinolones, considering the institution's resistance profile. These recommendations are based on expert panel opinions following a systematic literature review. Current evidence indicates that routine antibiotic prophylaxis prior to urodynamic studies is not warranted, as its primary benefit lies in reducing asymptomatic bacteriuria without significantly decreasing the incidence of symptomatic urinary tract infections. Prophylactic antibiotics should be reserved for patients at high risk of infection, with antimicrobial selection guided by local resistance patterns and an individualized assessment of risk and benefit.