scholarly journals Gentamicin bladder instillations decrease symptomatic urinary tract infections in neurogenic bladder patients on intermittent catheterization

2017 ◽  
Vol 11 (9) ◽  
pp. E350-4 ◽  
Author(s):  
Lindsey Cox ◽  
Chang He ◽  
Jack Bevins ◽  
J. Quentin Clemens ◽  
John T. Stoffel ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Neurogenic Bladder ◽  
Multidrug Resistant ◽  
Oral Antibiotic ◽  
Oral Antibiotics ◽  
Inclusion Criteria ◽  
Recurrent Utis ◽  
Symptomatic Urinary Tract Infection ◽  
Cord Injury ◽  
Tract Infections

Introduction: This study aimed to determine if gentamicin bladder instillations reduce the rate of symptomatic urinary tract infection (UTI) in neurogenic bladder (NGB) patients on intermittent self-catheterization (ISC) who have recurrent UTIs. Secondary aims were to examine the effects of intravesical gentamicin on the organism resistance patterns.Methods: We retrospectively reviewed our prospective NGB database. Inclusion criteria were NGB patients performing ISC exclusively for bladder drainage with clinical data available for six months before and six months after initiating prophylactic intravesical gentamicin instillations. Symptomatic UTIs were defined as symptoms consistent with UTI plus the need for antibiotic treatment.Results: Twenty-two patients met inclusion criteria; etiology of NGB was 63.6% spinal cord injury, 13.6% multiple sclerosis. Median time since injury/diagnosis was 14 years and 6/22 (27.3%) hadundergone urological reconstruction. Patients had fewer symptomatic UTI’s (median 4 vs. 1 episodes; p<0.004) and underwent fewer courses of oral antibiotics after initiating gentamicin (median 3.5 vs. 1; p<0.01). Days of oral antibiotic therapy decreased from 15 before to five after gentamicin, but this did not reach significance. There were fewer telephone encounters for UTI concerns per patient (median 3 vs. 0; p=0.03). The proportion of multidrug-resistant organisms in urine cultures decreased from 58.3%to 47.1% (p=0.04) and the rate of gentamicin resistance did not increase. Adverse events were mild and rare.Conclusions: Gentamicin bladder instillations decrease symptomatic UTI episodes and reduce oral antibiotics in patients with NGB on ISC who were suffering from recurrent UTIs. Antibiotic resistancedecreased while on gentamicin instillations.

Antibiotic cycling prevents urinary tract infections in spinal cord injury patients and limits the emergence of multidrug resistant organism

2015 ◽  
Vol 71 (4) ◽  
pp. 491-493 ◽  
Author(s):  
Claire Poirier ◽  
Aurélien Dinh ◽  
Jérôme Salomon ◽  
Nathalie Grall ◽  
Antoine Andremont ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Multidrug Resistant ◽  
Resistant Organism ◽  
Cord Injury ◽  
Antibiotic Cycling ◽  
Tract Infections

scholarly journals Fosfomycin susceptibility among ESBL producing gram negative bacilli causing urinary tract infections

2021 ◽  
Vol 8 (2) ◽  
pp. 142-145
Author(s):  
Rajeshwari K G
Keyword(s):  
Urinary Tract ◽  
Treatment Options ◽  
Study Finding ◽  
Multidrug Resistant ◽  
Oral Antibiotic ◽  
Testing Susceptibility ◽  
Tract Infections ◽  
Common Infection ◽  
Esbl Producers

Urinary tract infection is one of the common infection encountered in day to day practice. Due to emergence of drug resitance among uropathogens treatment options have become limited. Fosfomycin being a safe oral antibiotic is being used widely to treat multidrug resistant uropathogens. In the present study 831 (48.45%) samples that yielded significant growth were processed out of 1715 sample for ESBL detection by double disc synergy and phenotypic confirmatory method. E.coli constituted the predominant isolate (60.4%) followed by K.pneumoniae. 256 (30.80%) samples yielding growth were from out patients and 575 from inpatients. Over all 44% of isolates in the present study were ESBL producers. 50% of Ecoli were ESBL producers. 70.64% of ESBL isolates were susceptible to fosfomycin in vitro. Present study finding suggest that resistance to fosfomysin is on rise even though majority of ESBLs were sensitive to it. The current study recommends to use fosfomycin only after testing susceptibility among uropathogens.

Weekly Sequential Antibioprophylaxis for Recurrent Urinary Tract Infections Among Patients With Neurogenic Bladder: A Randomized Controlled Trial

2019 ◽  
Author(s):  
Aurélien Dinh ◽  
Marie-Charlotte Hallouin-Bernard ◽  
Benjamin Davido ◽  
Adrien Lemaignen ◽  
Frédérique Bouchand ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Neurogenic Bladder ◽  
Urinary Tract Infections ◽  
Bacterial Resistance ◽  
Controlled Trial ◽  
Group Versus ◽  
Control Group ◽  
Recurrent Urinary Tract Infections ◽  
Cord Injury ◽  
Tract Infections

Abstract Background Recurrent urinary tract infections (R-UTIs) are the main cause of morbidity and hospitalizations in subjects with neurogenic bladder (NB) due to spinal cord injury (SCI). We evaluated the efficacy of weekly oral cyclic antibiotic (WOCA) prophylaxis (ie, the alternate weekly administration of 2 antibiotics) in preventing R-UTIs. Methods Randomized (1:1), open-label, superiority-controlled trial compared WOCA prophylaxis to no prophylaxis (control) for 6 months in patients with NB due to SCI, using clean intermittent self-catheterization, and suffering from R-UTIs. Primary outcome was incidence of symptomatic antibiotic-treated UTIs. Secondary outcomes were number of febrile UTIs, number of hospitalizations, WOCA tolerance, antibiotic consumption, number of negative urine cultures, and emergence of bacterial resistance in urinary, intestinal, and nasal microbiota. Results Forty-five patients were either allocated to the WOCA group (n = 23) or the control group (n = 22). Median (IQR) incidence of symptomatic antibiotic-treated UTIs was 1.0 (0.5–2.5) in the WOCA group versus 2.5 (1.2–4.0) (P = .0241) in the control group. No febrile UTIs were recorded in the WOCA group versus 9 (45.0%) (P &lt; .001) in the control group. The median number of additional antibiotic treatment was 0.0 (IQR, 0.0–2.0) versus 3.0 (2.0–5.0) (P = .004) in the WOCA and control groups, respectively. Only few adverse events were reported. No impact on emergence of bacterial resistance was observed. Conclusions WOCA is efficient and well tolerated in preventing R-UTIs in SCI patients. In our study, we did not observe any emergence of antibiotic resistance in digestive and nasal microbiological cultures. Clinical Trials Registration NCT01388413.

scholarly journals Use of Intravesicular Amikacin Irrigations for the Treatment and Prophylaxis of Urinary Tract Infections in a Patient with Spina Bifida and Neurogenic Bladder: A Case Report

2011 ◽  
Vol 16 (2) ◽  
pp. 102-107
Author(s):  
Donna Huynh ◽  
Jill A. Morgan
Keyword(s):  
Case Report ◽  
Urinary Tract ◽  
Spina Bifida ◽  
Neurogenic Bladder ◽  
Urinary Tract Infections ◽  
Multidrug Resistant ◽  
Multiple Drug ◽  
Once Daily ◽  
Multiple Drug Resistant ◽  
Tract Infections

ABSTRACT This case report describes the use of intravesicular amikacin irrigations to treat and prevent urinary tract infections (UTIs) in a pediatric patient with spina bifida and neurogenic bladder. A 15 year old Hispanic female was admitted for a UTI caused by Enterobacter cloacae and multiple-drug resistant Pseudomonas aeruginosa. A 7 day course of daily intravenous amikacin and ceftazidime was initiated along with twice daily intravesicular amikacin irrigations (15 mg/30 mL) with a dwell time of 2 hours. The patient improved and was discharged on prophylactic Bactrim SS (sulfamethoxazole/trimethoprim) 1 tablet daily and intravesicular amikacin irrigations (15 mg/30 mL) once every other day. Approximately 2 months after discharge, the patient developed another UTI from multidrug resistant Escherichia coli and was treated with a 14 day course of daily intravenous ciprofloxacin accompanied by daily intravesicular amikacin irrigations. Adjunctive therapy with either once daily or twice daily intravesicular amikacin irrigations successfully treated the patient's UTI. However, prophylactic treatment with intravesicular amikacin failed to prevent future UTIs in this patient.

scholarly journals 1673. Epidemiology of Complicated Urinary Tract Infections (cUTIs) Presenting in Emergency Departments Across the United States (US)

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S822-S822
Author(s):  
Thomas Lodise ◽  
Teena Chopra ◽  
Brian Nathanson ◽  
Katherine Sulham
Keyword(s):  
Urinary Tract ◽  
Central Region ◽  
Regional Variation ◽  
Urine Culture ◽  
The United States ◽  
Treatment Decisions ◽  
Oral Antibiotics ◽  
Inclusion Criteria ◽  
Independent Contractor ◽  
Tract Infections

Abstract Background Complicated urinary tract infection (cUTI) is a common emergency department (ED) diagnosis. Results of urine culture and antimicrobial susceptibility testing are usually not available for up to 48 hours after an ED visit; therefore, diagnosis and treatment decisions are empiric and based on symptoms, physical findings, and underlying risk of resistance. We sought to understand the epidemiology and incidence of resistance to commonly used oral antibiotics among patients presenting to US EDs with cUTI. Methods A retrospective multi-center study using data from the Premier Healthcare Database (2013-18) was performed. Inclusion criteria: (1) age ≥ 18 years, (2) primary cUTI ED/inpatient discharge diagnosis, (3) positive blood or urine culture between index ED service days -5 to +2. Transfers from acute care facilities were excluded. We examined rates of resistance to the following drugs/classes: 3rd generation cephalosporins, fluoroquinolones, trimethoprim-sulfamethoxazole, fosfomycin, and nitrofurantoin in patients presenting to the ED, stratified by those who were ultimately admitted as inpatients vs. not. Regional variation by US Census Division was examined. Results 187,789 patients met inclusion criteria; 119,668 (63.7%) were admitted to the hospital. 4.6% had positive cultures only with gram-positive bacteria; the remainder had at least one gram-negative pathogen. E. coli was the most common infecting pathogen, present in 72.1% of ED-only infections and 51.4% of those admitted. 44.7% and 58.4% of ED-only and admitted patients, respectively, were resistant to at least 1 of the 5 drugs/classes examined (see table). We saw substantial regional variation; resistance to at least 3 of 5 drugs/classes across all patients ranged from 5.0% in West North Central region to 11.1% in East South Central region (national average: 9.1%). Resistance Rates by Drug/Drug Class and Hospital Admission Status Conclusion Patients with cUTI infections presenting to EDs in the US are frequently resistant to many commonly used oral antibiotics, even in patients not admitted to the hospital. Local epidemiology and resistance should be considered when making empiric treatment decisions in the ED. New oral options for cUTI patients are needed to address the growing challenge of resistance. Disclosures Thomas Lodise, PharmD, PhD, Paratek Pharmaceuticals, Inc. (Consultant) Teena Chopra, MD, MPH, Spero Therapeutics (Consultant, Advisor or Review Panel member) Brian Nathanson, PhD, Spero Therapeutics (Independent Contractor) Katherine Sulham, MPH, Spero Therapeutics (Independent Contractor)

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

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.

scholarly journals 1432. Patient-Reported Urinary Tract Infection Symptoms Among Veterans with Neurogenic Bladder

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S797-S798
Author(s):  
Margaret A Fitzpatrick ◽  
Marissa Wirth ◽  
Katie J Suda ◽  
Stephen Burns ◽  
Frances Weaver ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Neurogenic Bladder ◽  
Primary Care Providers ◽  
Care Providers ◽  
Specific Symptom ◽  
Cord Injury ◽  
Patient Reported ◽  
Urine Odor ◽  
Tract Infections ◽  
Specific Symptoms

Abstract Background Urinary tract infections (UTIs) and asymptomatic bacteria (AB) are common in patients with neurogenic bladder (NB) but differentiating between the two is challenging because laboratory tests cannot distinguish AB from UTI. This diagnostic uncertainty can lead to antibiotic overuse. Characterization of patient-reported symptoms from large cohorts of patients with NB can inform interventions to improve appropriate UTI diagnosis and management. Methods Retrospective cohort study of 1,797 adults with NB due to spinal cord injury/disorder (SCI/D), multiple sclerosis (MS), and/or Parkinson’s Disease (PD) accounted for 568 patients with UTI encounters (via ICD10) at 4 Veterans Affairs (VA) medical centers between 2017-2018. Demographic and clinical data were collected from national VA datasets. Medical record review was performed on a random sample of 198 encounters. Chi-square/Fisher’s exact test were used to compare symptoms by patient and encounter characteristics. Results Among the 198 encounters (mean age=65 years), 33% of patients had SCI/D, 29% PD, 20% MS, and 17% had more than one diagnosis. Most encounters were for men (88%) in inpatient or long-term care settings (62%). 76% of patients used bladder catheters; most indwelling (n=92). Fever was the most frequent symptom (30%), followed by change in urine odor, color, and/or consistency (26%) and lethargy/malaise (21%). Only 38% of encounters had a urinary tract-specific symptom recorded (e.g., dysuria); 81% had non-specific symptoms (e.g., fever, lethargy). 64% of encounters were deemed an appropriate UTI diagnosis. Characteristics in red in Figure 1 were significantly associated with non-specific symptoms (p&lt; 0.05). Patient and encounter characteristics found to be significantly associated with non-specific symptoms, p &lt; 0.05. Conclusion Symptoms not specific to the urinary tract are the most frequently reported symptoms in patients with NB and encounters with a UTI diagnosis. Change in urine odor/color were reported often; however, guidelines recommend against using these for UTI diagnosis. Providers should ensure that alternate sources of non-specific symptoms are evaluated prior to attributing them to UTI. Antibiotic stewardship interventions targeted to physical medicine and rehabilitation (PM&R) and primary care providers in inpatient settings may improve UTI diagnosis in patients with NB. Disclosures Charlesnika T. Evans, PhD, MPH, BioK+ (Consultant)

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