Retrospective Observational Study of Risk Factors for Febrile Infectious Complications after Urodynamic Studies in Patients with Suspected Neurogenic Lower Urinary Tract Disturbance

Abstract

<b><i>Introduction:</i></b> We retrospectively investigated the risk factors for post-urodynamic study (UDS) infectious complications in long-term hospitalized inpatients with suspected neurogenic lower urinary tract disturbance (NLUTD) in a monocenter study, to accurately assess post-UDS urinary tract infections (UTI). <b><i>Methods:</i></b> We retrospectively analyzed data including background information, UDS-related data, and potential risk factors for infection from 489 NLUTD-suspected inpatients who underwent UDS from 2015 to 2019 and examined the risk factors for post-UDS infectious complications using univariate and multivariate statistical analyses. <b><i>Results:</i></b> Symptomatic post-UDS UTI occurred in 20 out of 489 (4.1%) patients, including 3 (15%) with recurrent UTI. During follow-up prior to UDS for 1 year, 220 cases were investigated by urine culture revealing <i>Escherichia coli</i> (<i>n</i> = 77), <i>Klebsiella pneumoniae</i> (<i>n</i> = 29), <i>Enterococcus faecalis</i> (<i>n</i> = 18), extended-spectrum beta-lactamase-producing <i>E. coli</i> (<i>n</i> = 17), and <i>Pseudomonas aeruginosa</i> (<i>n</i> = 9). As risk factors for post-UDS infectious complications, American Spinal Injury Association impairment scale (AIS): AIS ≧ C (A or B or C) (hazard ratio: 4.29, <i>p</i> = 0.0076), management method of urination (hazard ratio: 4.30, <i>p</i> = 0.048), and age (hazard ratio: 1.04, <i>p</i> = 0.025) were significantly correlated with the occurrence of post-UDS infection. <b><i>Conclusions:</i></b> The significant risk factors for post-UDS UTI were AIS ≧ C, management method of urination, and age in the suspected NLUTD patient context. This study was originally started with the goal of reducing unnecessary antibiotics and may contribute to the proper use of antibiotics based on antimicrobial stewardship.