To evaluate the clinical effectiveness of a culture-based antibiotic prophylaxis (AP) protocol before urodynamic studies (UDS), and to compare antibiotic use and infection rates against recommendations from the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU) Best Practice Policy Statement (BPPS).

A retrospective cohort study of 1666 adult patients who underwent UDS. All patients were managed under a local protocol requiring a urine culture (UC) prior to UDS. Patients with positive UC received an oral antibiotic course, which was initiated 72 hours prior to the study. Post-UDS UTI was defined as a symptomatic infection confirmed by positive UC.

Three hundred fifty-two (21.1%) patients with positive UC, treated with AP. Among the remaining 1314 (78.9%) patients with negative UC, 62% had SUFU-defined risk factors but did not receive AP. The overall post-procedural UTI rate was 1.9% in the no-AP group and 1.7% in patients with positive UC who received AP ( P = .807). No statistically significant difference in UTI rates was found between “index” and “non-index” patients (0.7% vs 1.8%, P = .126). Applying SUFU BPPS would have required AP in 83.4% of patients, while our approach reduced this by more than 60%.

A UC-guided approach minimizes unnecessary antibiotic exposure without compromising patient safety. We support the integration of culture-based decision-making in urodynamic practice, especially in the context of rising antimicrobial resistance.