Urinary tract infections (UTIs) are a heavy burden on the healthcare system today. UTIs are also one of the most common complications among people living with a neurogenic bladder, causing significant complications and health hazards. New clinical research investigates the clinical problem and demonstrates that UTIs are still among the leading causes of death in people with a neurogenic bladder.
On average, people with a neurogenic bladder experience 2 UTI events every year, requiring repeated antibiotic treatments. Frequent use of antibiotics is one of the main contributors to the high prevalence of antibiotic-resistant bacteria today, and as a result, UTIs are getting more expensive and more difficult to treat. As a consequence, there is a major focus in clinical research on the search for non-antibiotic prophylactic treatment for UTIs.
One of the recently published studies summarizes the currently available evidence on probiotic use in preventing UTIs in people with neurogenic bladder. Although the evidence available so far is inconclusive, the study makes a strong recommendation for further research in the field, preferably using oral probiotics. UTI prevention strategies also include targeting antibiotic use in children, as early exposure to antibiotics in childhood seems both to have negative systemic effects and to lead to increased resistance.
A more traditional way to prevent UTIs is to restrict the use of indwelling catheters. This is frequently described in the scientific literature and this month's publications show examples of revised catheter protocols in an intensive care setting and in women undergoing hysterectomy. Another publication suggests that use of bladder instillations of antibiotics can reduce UTIs in people with neurogenic bladder without causing increased antibiotic resistance in bacteria.
One part of preventing UTIs is to recognize the clinical signs and symptoms. This is why signs and symptoms of UTIs associated with a neurogenic bladder and/or catheter use are explored in two new publications. The findings suggest that UTI symptoms or signs can be categorized into the following groups:
1) changes in urine
2) changes in bladder emptying
3) fever
4) general and/or systemic symptoms
5) pain and discomfort
Cloudy and foul-smelling urine seems to be the most reliable indicator of UTI.
Summary of Publications
Probiotics for preventing urinary tract infection in people with neuropathic bladder.
https://www.ncbi.nlm.nih.gov/pubmed/28884476
Author and Origin
Toh SL, Boswell-Ruys CL, Lee BSB, Simpson JM, Clezy KR. Australia
Summary
Meta-analysis of 3 studies (including 110 patients) investigating use of probiotics to prevent symptomatic urinary tract infection (UTI) in people with neurogenic bladder.
Conclusions
Only studies using bladder instillation of E. coli were found. Although treatment was considered generally safe, the risk reduction effect was unclear.
Comments
Cochrane review summarizing the current available evidence on probiotic use to prevent recurrent UTI in people with neurogenic bladder. There is still no evidence on oral probiotics, and the effect of probiotics instilled into the bladder was not clear.
This publication is described further in the highlight section.
Urinary Tract Infection in Children: Management in the Era of Antibiotic Resistance—A Pediatric Urologist’s View.
https://doi.org/10.1016/j.euf.2017.09.013
Author and Origin
Kutasy B, Coyle D, Fossum M. Sweden
Summary
Review of antibiotic usage and future management of bacterial resistance in pediatric urology.
Conclusions
Early exposure to antibiotics in childhood seems to have negative systemic effects related to neurocognitive function, body metabolism, and fat distribution. It can also lead to increased resistance and costs, and reduce the effect of future treatment on infections.
Comments
Review suggesting that pediatric urologists have a key role in preventing antibiotic resistance and its consequences.
Gentamicin bladder instillations decrease symptomatic urinary tract infections in neurogenic bladder patients on intermittent catheterization.
http://dx.doi.org/10.5489/cuaj.4434
Author and Origin
Cox L, He C, Bevins J, Clemens QJ, Stoffel JT, Cameron AP. US
Summary
Observational retrospective study exploring the use of bladder instillations of antibiotics in 22 patients using intermittent catheterization due to neurogenic bladder.
Conclusions
Patients seemed to have fewer symptomatic UTIs and fewer courses of oral antibiotics after initiating bladder instillations of antibiotics.
Comments
Study exploring the use of bladder instillations of antibiotics to reduce UTIs in people with neurogenic bladder using intermittent catheterization.
Reducing catheter-associated urinary tract infections in the ICU.
https://www.ncbi.nlm.nih.gov/pubmed/28858916
Author and Origin
Sampathkumar P. US
Summary
Review investigating catheter-associated urinary tract infection (CAUTI) reduction strategies that are specific to the intensive care setting.
Conclusions
Reduced catheter usage, improved catheter care, and stewardship of urine cultures are identified as the
main events leading to CAUTI reduction in the intensive care unit setting.
Comments
Review exploring CAUTI prevention strategies in the intensive care setting, identifying reduced indwelling catheter use as one contributing solution.
Early catheter removal following laparoscopic radical hysterectomy for cervical cancer: assessment of a new bladder care protocol.
https://www.ncbi.nlm.nih.gov/pubmed/28782402
Author and Origin
Campbell P, Casement M, Addley S, Dobbs S, Harley I, Nagar H. Ireland
Summary
Observational retrospective study of post-operative bladder care in 78 patients who underwent hysterectomy, had early indwelling catheter removal, and had intermittent catheterization as their first-line management of voiding dysfunction.
Conclusions
The incidence of post-operative voiding dysfunction was 44 %, of whom 88 % were managed with
intermittent catheterization. 82 % regained normal voiding function and the average hospital stay was
4.2 days.
Comments
Study showing epidemiological data on intermittent catheterization in favor of long-term indwelling use of
catheters after hysterectomy.
Enhancing quality practice for prevention and diagnosis of urinary tract infection during inpatient spinal cord rehabilitation.
https://www.ncbi.nlm.nih.gov/pubmed/28872426
Author and Origin
Alavinia SM, Omidvar M, Farahani F, Bayley M, Zee J, Craven BC. Canada
Summary
Observational retrospective study describing demographics and occurrence and symptoms of urinary
tract infections (UTI) during spinal cord rehabilitation in 55 inpatients.
Conclusions
UTI was seen in 58 % of patients, and the most frequent symptoms/signs were foul-smelling urine (41 %), fever (34 %), change in urine color (31%), and incontinence (25 %). Cloudy and foul smelling urine seems to be the most reliable indicator of UTI.
Comments
Study investigating predictive value of UTI symptoms associated with spinal cord rehabilitation and
intermittent catheter use in hospital.
Intermittent catheter users’ symptom identification, description and management of
urinary tract infection: a qualitative study.
https://www.ncbi.nlm.nih.gov/pubmed/28871020
Author and Origin
Okamoto I, Prieto J, Avery M, Moore K, Fader M, Sartain S, Clancy B. UK
Summary
Observational interview study investigating urinary tract infection (UTI) in 30 intermittent catheter
users.
Conclusions
UTI signs and symptoms seem to fit within one of the following categories: 1) changes to urine, 2)
changes in bladder emptying, 3) fever, 4) general and/or systemic symptoms, and 5) pain/discomfort.
Comments
Study investigating UTI signs and symptoms associated with intermittent catheter use.
Open access.
This blog post is an extract of the Science Alert from Oct 2017 (76040-USX-1710)
