Determining risk factors for symptomatic urinary tract infection following trial of void: A retrospective analysis

Abstract

Objective: To investigate the incidence and risk factors for symptomatic urinary tract infection (UTI) following trial of void (TOV) to guide patient selection for antibiotic prophylaxis. Methods: A retrospective study considered all patients who underwent successful TOV across two separate 12-month periods at a tertiary hospital. Routine prophylactic antibiotics were not administered. Results: The 183 patients included were mostly men (91.3%) aged ⩾ 65 years (78.7%). Thirty-seven (20.3%) had recent urological surgery. The incidence of UTI following TOV was 12.6% (23/183); median duration of onset was 3 days (interquartile range = 2–9). Cystitis was most common (17/183; 9.3%), while four patients (2.2%) suffered urosepsis. There were no singular statistically significant risk factors for increasing the risk of UTI following TOV, however, ⩾ 2 risk factors showed numerically higher odds of UTI compared to ⩽ 1 risk factor (15.6% vs 4.2%; odds ratio = 4.24, 95% confidence interval = 0.96–18.80, p = 0.058). Atypical organisms resistant to most oral antibiotics were predominantly cultured, however, 89% sensitivity to ciprofloxacin was observed. Conclusion: The incidence of UTI following TOV was higher than anticipated. Reliable identification of at-risk patients for antibiotic prophylaxis is likely to be complicated. Further research is needed to confirm patient selection prior to confirmatory trials. Level of evidence: 2b