Neomycin-polymyxin or gentamicin bladder instillations decrease symptomatic urinary tract infections in neurogenic bladder patients on clean intermittent catheterization

Objective: To assess the efficacy and safety of different modalities of bladder instillation in patients with neurogenic bladder practicing intermittent catheterization. Methods: A systematic review of the literature were conducted using two databases: Medline via PubMed and Scopus. Articles evaluating bladder instillation in patients with neurogenic bladder, who are practicing intermittent catheterization, were collected and assessed for the efficacy and safety of the studied agent by two different reviewers. Results: Among the 1896 studies, eight involving 346 patients with neurogenic bladder, were included in this systematic review according to the PRISMA protocols. Gentamicin, Hyaluronic acid, and Lactobacillus rhamnosus was found to decrease the incidence of urinary tract infections, the former reduced multidrug-resistant organisms. Kanamycin-colistin, showed a drop in the mean incidence of bacteriuria in males only. Trisdine, the only studied antiseptic, significantly reduced bacteriuria. Neomycin, however, showed no efficacy in term of bacteriuria. Regarding safety, when evaluated, no major adverse events were reported with any of the studied modalities. Conclusion: Bladder instillations of either antibiotics, antiseptics, hyaluronic acid, or Lactobacillus rhamnosus GG are efficient and safe in patients having neurogenic bladder, with recurrent urinary tract infections and practicing clean intermittent catheterization, with gentamicin being the most recommended product among the different studied agents.

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604 LOW-DOSE CHEMOPROPHYLAXIS AND PREVENTION OF URINARY TRACT INFECTIONS IN CHILDREN WITH MENINGOMYELOCELE AND CLEAN INTERMITTENT CATHETERIZATION

The Journal of Urology ◽

10.1016/j.juro.2010.02.918 ◽

2010 ◽

Vol 183 (4S) ◽

Cited By ~ 1

Author(s):

Bas Zegers ◽

Catharine de Jong-de Vos van Steenwijk ◽

Tom de Jong ◽

Cuno Uiterwaal ◽

Jan van Gool ◽

...

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Low Dose ◽

Intermittent Catheterization ◽

Clean Intermittent Catheterization ◽

Tract Infections

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Characteristics of Symptomatic and Asymptomatic Bacteriuria in Patients with Neurogenic Bladder under Neurorehabilitation

10.21203/rs.3.rs-19300/v1 ◽

2020 ◽

Author(s):

Fauster O. B. Lopes ◽

Maria Rosa Q. Bomfim ◽

Sílvio G. Monteiro ◽

Marcello T. da Silva ◽

Virginia Maria L. S. de Pinho ◽

...

Keyword(s):

Comparative Analysis ◽

Urinary Tract ◽

Neurogenic Bladder ◽

Urinary Tract Infections ◽

Laboratory Data ◽

Asymptomatic Bacteriuria ◽

Intermittent Catheterization ◽

Laboratory Test Results ◽

Cord Injury ◽

Tract Infections

Abstract Background: The definitions of urinary tract infections (UTI) and asymptomatic bacteriuria (ABU) are problematic to apply in patients with neurogenic bladder (NB). Here, we carried out a comparative analysis of the main clinical and laboratory data of NB patients with UTI and ABU.Methods: One hundred ninety five patients with neurogenic bladder were evaluated in the Urology Sector at a neurorehabilitation hospital. Patients were divided into either ABU or UTI group based on clinical and laboratory data. The sociodemographic data, clinical history, and laboratory test results were collected and used in the comparative analysis.Results: Of the patients evaluated, 161 (82.6%) had ABU. Patients of different age groups were affected, predominantly young adults (20-39 years). The median time of bladder involvement was 8.9 years (0-35). Neurogenic bowel was observed in 97.5% of cases and renal lithiasis in 11.3%. The main underlying pathologies leading to urologic involvement were spinal cord injury, myelomeningocele, stroke, and neoplasms. Only 16.4% of patients were not on intermittent catheterization, in which the risk of recurrent infection was higher than in patients who were under for intermittent bladder catheterization (p = 0.016, OR 2.65). Infection rates were significantly different between patients with histories of recurrent urinary tract infections (asymptomatic bacteriuria 29.8% vs 52.9% infection, p = 0.016). Leukocyturia was frequent in both groups, however, our data suggested that only values ≤ 30 cells/high power field excluded infection.Conclusions: In summary, intermittent catheterization was observed to be essential in the prevention of recurrent UTI, as well as the need to adjust the reference values for leukocyturia in the definition of the infectious condition.

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The impact of constant antibiotic prophylaxis in children affected by spinal dysraphism performing clean intermittent catheterization: a 2-year monocentric retrospective analysis

Child s Nervous System ◽

10.1007/s00381-021-05337-y ◽

2021 ◽

Author(s):

Francesco Mariani ◽

Emanuele Ausili ◽

Margherita Zona ◽

Giacomo Grotti ◽

Antonietta Curatola ◽

...

Keyword(s):

Urinary Tract ◽

Spina Bifida ◽

Antibiotic Prophylaxis ◽

Urinary Tract Infections ◽

Spinal Dysraphism ◽

Intermittent Catheterization ◽

Clean Intermittent Catheterization ◽

Tract Infections ◽

The Impact

Abstract Introduction Spinal dysraphism (SD) is a general term used to refer to developmental abnormalities of the spine that involves many clinical conditions including myelomeningocele (MMC). In these patients, neurogenic bladder (NB) is a common and predisposing factor for renal damage; the most frequently used approach to manage this situation is based on clean intermittent catheterization (CIC) and anticholinergic drugs. Urinary tract infections (UTIs) are a significant concern for these patients, and antibiotic prophylaxis is frequently used even if it is still a debated topic of literature. The purpose of this paper is to investigate the role and the real effectiveness of antibiotic prophylaxis in the reduction of incidence of UTIs in patients with spina bifida performing CIC. Methods We collected data of all patients performing CIC, who did their last follow-up visit in the period between January 2019 and January 2021, followed at the children multidisciplinary Spina Bifida Center of A. Gemelli Hospital in Rome. Data collected included age at referral, gender, type of SD lesion, serum creatinine and cystatin C levels, the use of anticholinergic medications, antibiotic prophylaxis and type of prophylaxis (oral/endovesical), age of starting prophylaxis with its duration/adherence, number of CIC/day and its duration, episodes of UTIs in the 2 years prior to the last follow-up, and presence and grade of vesical-ureteric reflux (VUR) on cystourethrogram. Results A total of 121 patients with SD performing CIC was included in the study; 66 (54%) presented ≥ 1 episode of UTIs in the last two years and 55 (46%) none. During the study period, 85 (70%) patients received antibiotic prophylaxis (ABP group) and 36 (30%) did not (NABP group): no statistically significative difference in terms of UTI development was observed between the two groups (p = 0.17). We also evaluated compliance to the therapy; 71 patients (59%) took antibiotic prophylaxis constantly (CABP group) and 50 (41%) did not do antibiotic prophylaxis constantly or did not do antibiotic prophylaxis at all (NCABP group): we observed a statistically significative difference in terms of UTIs with a 2.2 times higher risk of development at least one episode of UTIs in NCABP group. Conclusion In conclusion, antibiotic prophylaxis performed constantly, without interruption, is associated with a lower risk of developing urinary tract infections and consequently to develop renal failure in adulthood.

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Clean, Intermittent Catheterization of Infants With Neurogenic Bladder

PEDIATRICS ◽

10.1542/peds.84.1.78 ◽

1989 ◽

Vol 84 (1) ◽

pp. 78-82

Author(s):

David B. Joseph ◽

Stuart B. Bauer ◽

Arnold H. Colodny ◽

James Mandell ◽

Alan B. Retik

Keyword(s):

Urinary Tract ◽

Neurogenic Bladder ◽

Bladder Dysfunction ◽

Upper Urinary Tract ◽

Febrile Episode ◽

Intermittent Catheterization ◽

Early Age ◽

Clean Intermittent Catheterization ◽

Detrusor Sphincter Dyssynergia ◽

Tract Infections

Clean, intermittent catheterization was instituted in 38 babies with myelodysplasia who were thought to be at risk for upper urinary tract deterioration because of neurogenic bladder dysfunction. There were 19 patients 2 weeks to 12 months of age, 11 were 1 to 2 years of age, and 8 were older than 2 years. Effectiveness of clean, intermittent catheterization was determined by maintenance of upper urinary tract stability. Upper urinary tracts improved or remained stable in 13 of 16 infants (81%) with reflux and 16 of 18 infants (89%) with detrusor-sphincter dyssynergia. Bacteriuria was present in 16 (42%), with only 2 infants (5%) having a febrile episode; no infant required hospitalization because of urinary tract infections. No further complications were identified in infants who were cleanly and intermittently catheterized. Most families found clean, intermittent catheterization of their infants easy to master and not stressful, and their children adjusted to it at an early age.

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