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.
https://www.ncbi.nlm.nih.gov/pubmed/28884476
Author and Origin
Toh SL, Boswell-Ruys CL, Lee BSB, Simpson JM, Clezy KR. Australia
Meta-analysis of 3 studies (including 110 patients) investigating use of probiotics to prevent symptomatic urinary tract infection (UTI) in people with neurogenic bladder.
Only studies using bladder instillation of E. coli were found. Although treatment was considered generally safe, the risk reduction effect was unclear.
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.
https://doi.org/10.1016/j.euf.2017.09.013
Author and Origin
Kutasy B, Coyle D, Fossum M. Sweden
Review of antibiotic usage and future management of bacterial resistance in pediatric urology.
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.
Review suggesting that pediatric urologists have a key role in preventing antibiotic resistance and its consequences.
http://dx.doi.org/10.5489/cuaj.4434
Author and Origin
Cox L, He C, Bevins J, Clemens QJ, Stoffel JT, Cameron AP. US
Observational retrospective study exploring the use of bladder instillations of antibiotics in 22 patients using intermittent catheterization due to neurogenic bladder.
Patients seemed to have fewer symptomatic UTIs and fewer courses of oral antibiotics after initiating bladder instillations of antibiotics.
Study exploring the use of bladder instillations of antibiotics to reduce UTIs in people with neurogenic bladder using intermittent catheterization.
https://www.ncbi.nlm.nih.gov/pubmed/28858916
Sampathkumar P. US
Review investigating catheter-associated urinary tract infection (CAUTI) reduction strategies that are specific to the intensive care setting.
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.
Review exploring CAUTI prevention strategies in the intensive care setting, identifying reduced indwelling catheter use as one contributing solution.
https://www.ncbi.nlm.nih.gov/pubmed/28782402
Campbell P, Casement M, Addley S, Dobbs S, Harley I, Nagar H. Ireland
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.
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.
Study showing epidemiological data on intermittent catheterization in favor of long-term indwelling use of
catheters after hysterectomy.
https://www.ncbi.nlm.nih.gov/pubmed/28872426
Author and Origin
Alavinia SM, Omidvar M, Farahani F, Bayley M, Zee J, Craven BC. Canada
Observational retrospective study describing demographics and occurrence and symptoms of urinary
tract infections (UTI) during spinal cord rehabilitation in 55 inpatients.
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.
Study investigating predictive value of UTI symptoms associated with spinal cord rehabilitation and
intermittent catheter use in hospital.
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
Observational interview study investigating urinary tract infection (UTI) in 30 intermittent catheter
users.
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.
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)