Antibiotic Prophylaxis at Urinary Catheter Removal Prevents Urinary Tract Infection After Kidney Transplantation

BackgroundUrinary tract infections (UTI) are common nosocomial infections in kidney transplant recipients, with limited evidence to guide antibiotic prophylaxis at urinary catheter removal. The aim of our study was to evaluate the effect of short-term antibiotic therapy at the moment of catheter removal after kidney transplantation.MethodsTwenty kidney transplant recipients received 250 mg of ciprofloxacin orally twice daily 1 day before and at the day of the removal of the urinary catheter and were compared with 20 kidney transplant recipients without prophylaxis. UTI was diagnosed by use of urine culture and clinical signs.ResultsAll patients were comparable in sex, age, etiology of end-stage renal failure, immunosuppression, donor type, and initial function. After catheter removal at the 6th postoperative day, a rapid rise of UTI in kidney transplant recipients without prophylaxis (n = 12, 60%) was observed, whereas in patients with antibiotic prophylaxis the rate of UTI could be significantly reduced to 20%. Escherichia coli was the most isolated pathogen in the patients with UTI and was detected at the catheter tip in more than 50% of cases. In 2 patients (10%) after antibiotic prophylaxis, a ciprofloxacin-resistant E coli strain was detected.ConclusionsThe use of antibiotic prophylaxis during urinary catheter removal is recommended to prevent UTI in kidney transplant recipients.     

A pilot randomized double-blind placebo-controlled trial on the use of antibiotics on urinary catheter removal to reduce the rate of urinary tract infection: the pitfalls of ciprofloxacin

OBJECTIVE: To assess if a short course of antibiotics starting at the time of the removing a short-term urethral catheter decreases the incidence of subsequent urinary tract infection (UTI). PATIENTS AND METHODS: Patients across specialities with a urethral catheter in situ for >/= 48 h and 相似文献   

The effect of continuous epidural infusion of a combination of 1% mepivacaine and buprenorphine for post-operative pain relief

Using a portable 2 ml.hr-1 type infusor (Baxter Infusor), the effect of continuous epidural infusion for post-operative pain relief for 72 hours was studied in 32 patients after upper abdominal surgery. The patients were randomly allocated into four groups: Group 1 (n = 8) received continuous epidural infusion of 1% mepivacaine and buprenorphine 0.2 mg (48 ml.hr-1); group 2 (n = 8) 1% mepivacaine and buprenorphine 0.4 mg (48 ml.hr-1); Group 3 (n = 8) saline and buprenorphine 0.2 mg (48 ml.hr-1); Group 4 (n = 8) saline and buprenorphine 0.4 mg (48 ml.hr-1). The effect was evaluated at intervals of 12-hour until 72 hours postoperatively. Patients received supplemental buprenorphine intramuscularly as needed. In each period during the 12 to 72-hour after operation, the percentage of the patients who needed no supplemental buprenorphine was 62.5-100%, which is higher than during the 0 to 12-hour (25.0%). The percentage of the patients who showed no pain on coughing and changing in position in Group 1 and 2 was higher than in Group 3 and 4 in each period (P less than 0.05 12-24 and 36-72 hr). Continuous epidural infusion using Baxter Infusor with the combination of 1% mepivacaine and buprenorphine is effective for alleviating postoperative pain during the 12 to 72 hours after the operation, and for prevention of pulmonary complications.     

Efficacy of ciprofloxacin in urinary tract infections and risk factors for ciprofloxacin-resistant infections

Objectives : The study was undertaken to assess the safety and efficacy of sequential intravenous and oral ciprofloxacin in the treatment of moderate-to-severe urinary tract infections (UTI), and to identify risk factors for acquiring UTI caused by ciprofloxacin-resistant organisms. Materials and Methods : Using a prospective, open, single-centre study design, hospitalized patients with a clinical diagnosis of moderately severe UTI were enrolled. After a minimum of 3 days of intravenous ciprofloxacin, patients were switched to oral therapy. Assessment for response and analysis of risk factors were performed at the end of therapy. Results : Between December 1996 and November 1997, a total of 66 patients met the criteria for efficacy evaluation. Among the 55 patients with ciprofloxacin-sensitive organisms, 51 patients (93%) were cured. Persisting infection was noted in three patients (5%) and one patient (2%) was re-infected with a ciprofloxacin-resistant organism. Of the organisms isolated, 14 (19%) were resistant to ciprofloxacin. The presence of prostatic obstruction (odds ratio 6.02, 95% confidence interval (CI) 1.28–28.30, P = 0.02) and recurrent UTI (odds ratio 8.63, 95% CI 1.81–41.17, P = 0.007) were independently associated with infections caused by ciprofloxacin-resistant organisms. Adverse events were reported in 5 patients (8%) but no premature discontinuation or mortality was documented. Conclusion : Sequential therapy with oral therapy after initial parenteral ciprofloxacin is safe and effective in the management of moderate-to-severe UTI in appropriately selected patients.      

Clinical studies on enoxacin in urinary tract infection

Enoxacin was administered orally to 49 out-patients with urinary tract infections (UTI) at the doses of 600 mg/day and clinical effects were evaluated. Out of 13 patients with simple acute UTI evaluated by the UTI criteria, the results were excellent in 8 cases and good in 5 cases. Overall effectiveness rate was 100%. Out of 10 patients with simple acute UTI evaluated on over 5-day administration, the results were excellent in 9 cases and good in 1 case. Overall effectiveness rate was 100%. Out of 14 patients with simple acute UTI evaluated by our own criteria because their bacteriological response is unknown, the results were excellent in 7 cases and good in 7 cases. Overall effectiveness rate was 100%. Out of 12 patients with chronic complicated UTI evaluated by the UTI criteria, the results were excellent in 6 cases, good in 3 cases and poor in 3 cases. Overall effectiveness rate was 75.0%. Poor effective cases were mainly found in ones with mixed infection. Sensitivity test using discs did not always correspond to the bacteriological effect in cases with chronic complicated UTI. An adverse reaction was noted in 3 patients (6.1%). Two cases had gastrointestinal symptoms and 1 case had skin eruption. All symptoms were readily improved after discontinuing administration. From the above results, Enoxacin was considered to be a useful agent for urinary tract infection.     

Comparison of cefixime and co-trimoxazole in acute uncomplicated urinary tract infection. A double-blind general practice study

Five hundred and twenty-eight patients with presumptive acute uncomplicated urinary tract infection (UTI) were randomly assigned to receive cefixime 400 mg once daily, cefixime 200 mg twice daily or co-trimoxazole 2 tablets twice a day for 10 days; 477 completed at least 5 days of therapy. Of the patients 342 (65%) had positive baseline urine cultures, yielding 353 pathogens. A microbiological response was determined for 280 pathogens (79%), eradication being observed in over 94% of isolates; 153 pathogens (43%) were sensitive to both cefixime and co-trimoxazole and eradication was observed in over 96% of cases. Clinical response correlated well with microbiological response. The incidence of diarrhoea and stool changes was higher (P less than 0.005) in the patients who received cefixime once daily than in the other groups. There was a significantly higher incidence of stool changes with cefixime twice daily than with co-trimoxazole (P less than 0.05), but these did not necessitate discontinuation of therapy. Nausea was commoner with co-trimoxazole (P less than 0.05). The majority of pathogens isolated were Escherichia coli, Proteus mirabilis and staphylococci. Approximately 24% of E. coli were resistant in vitro to co-trimoxazole (P less than 0.005). Cefixime 200 mg twice daily is an effective and safe alternative to co-trimoxazole in the management of acute uncomplicated UTI.     

Significance of pretransplant urinary tract infection in short-term renal allograft function and survival

Renal transplant recipients are susceptible to postoperative infections, among which those in the urinary tract (UTI) are the most common. We examined the effect of pretransplant bacterial UTI on the incidence of posttransplant UTI as well as complications and short-term outcomes. PATIENTS AND METHODS: We examined the case records of 100 patients who underwent living-related donor renal transplantation at our institute from November 2006 to June 2007. RESULTS: Nineteen patients had positive pretransplant bacterial urine cultures and four required native nephrectomy for control of persistent bacterial UTI. All patients were transplanted under a tolerance induction protocol using low-dose immunosuppression after negative suprapubic culture reports. There was no urinary leak/obstruction or vascular complication. The incidence of postoperative bacterial UTI was 31.6% (6 of 19) compared with 6.2% (6 of 81) among patients without pretransplant UTI. E. coli was the most common isolated organism. All patients were doing well with 100% graft survival at 3 months and a mean serum creatinine of 1.27 mg%. CONCLUSION: Preoperative UTI predicted an increased likelihood of postoperative UTI without a significant effect on graft/patient survival and graft function.     

A long-term, multicenter, double-blind study of an Escherichia coli extract (OM-89) in female patients with recurrent urinary tract infections

OBJECTIVE: To investigate the long-term preventive effect of the immunotherapeutic OM-89 versus placebo in uncomplicated recurrent UTI in a large cohort of female patients only. METHODS: Adult female patients could enroll in this multicenter, double-blind study if they had acute UTI at the enrollment visit and positive results of urinalysis (> or =10(3)bacteria/ml). Patients received the immunotherapeutic OM-89 or a matching placebo; 1 capsule per day for 90 days, 3 months without treatment, then the first 10 days in Months 7, 8 and 9 and were followed up during 12 months. Primary efficacy criteria were UTI rates over 12 months, distribution of UTIs and proportion of patients with UTI. RESULTS: A total of 453 patients were treated, 231 in the active group and 222 in the placebo group. Mean rate of post-baseline UTIs was significantly lower in the active group than in the placebo group (0.84 vs. 1.28; p<0.003), corresponding to a 34% reduction of UTIs in patients treated with OM-89. In the active group, 93 patients (40.3%) had 185 post-baseline UTIs, compared to 276 UTIs in 122 patients (55.0%) in the placebo group (p=0.001). The safety profile of OM-89 was good and consistent with that reported in previous studies. CONCLUSIONS: OM-89 significantly reduced the incidence of UTI during the 12 months of the study including 3 months of treatment and three 10-day booster courses. These results confirm that OM-89 is a valuable component of the management of recurrent UTI.     

The clinical efficacy of SNRI milnacipran in the treatment of hot flushes with prostate cancer hormonally treated

We investigated the clinical efficacy of milnacipran (Serotonin-Noradrenalin Reuptake Inhibitor: SNRI) in prostate cancer patients who suffer from hot flushes. Our study included 12 patients who had taken hormone therapy for at least 3 months prior to the trial entry. All patients had severe hot flushes at least 3 times daily. Among 12 patients, 7 subjects received milnacipran 25 mg orally once a day and 5 subjects received 50mg once a day. The questionnaire was used to measure the frequency and severity of hot flushes at baseline, and at 6 and 12 weeks. At 12 weeks, 9 patients were available for the evaluation. Four patients received 50 mg per day and 5 patients received 25 mg per day. The patients with > or =50% decrease in baseline hot flash score were observed in 3 out of 4 who received 50 mg and 2 out of 5 who received 25 mg per day. The frequency of hot flushes had significantly decreased at the 12 weeks period than the baseline in the milnacipran 50 mg per day treatment group (p < 0.05, paired t-test). Adverse events were observed in 3 patients: 2 cases of nausea and 1 case of constipation. However, all of them were mild to moderate. These results indicated that milnacipran 50 mg per day therapy is effective in the treatment of hot flushes, which is the side effect of hormone therapy for prostate cancer.     

Hypercalciuria and recurrent urinary tract infections: incidence and symptoms in children over 5 years of age

Hypercalciuria is an important and common risk factor in the formation of renal stones. In this study we evaluated the incidence and the clinical presentation of hypercalciuria in 75 children over 5 years of age with the diagnosis of recurrent urinary tract infection (UTI). We measured random urinary calcium/creatinine value (three times), 24-h urinary calcium excretion, serum calcium, phosphorus, electrolytes, blood gas, blood urea nitrogen and creatinine levels. Hypercalciuria was found in 32 patients (43%). The mean urinary calcium/creatinine ratio for hypercalciuric patients was 0.50±0.21 mg/mg (min: 0.24, max: 2.60). The mean urinary calcium/creatinine ratio for the rest of the study population—those without hypercalciuria—was 0.10±0.04 mg/mg (min: 0.01, max: 0.18). Presenting symptoms of the hypercalciuric patients and normocalciuric patients were similar. History of familial urolithiasis was positive in 19 patients (59%). Predisposing urinary tract abnormalities in recurrent UTI was shown in 12 of the hypercalciuric patients (12/32, 37.5%) and 8 of the normocalciuric patients (8/43, 19%) without a statistically significant difference between. We conclude that hypercalciuria is not a rare finding among recurrent UTI cases in Turkish children. Hypercalciuria does not modify the clinical presentation of UTI, and we suggest the investigation of urinary calcium excretion in children with recurrent UTI.     

Bacteriuria and antibiotic resistance in catheter urine specimens following radical prostatectomy

ObjectiveThere are increasing reports of infectious complications following prostate biopsy due to fluoroquinolone resistance. To determine infectious complications at catheter removal following radical prostatectomy (RP), another setting in daily urological practice where fluoroquinolone prophylaxis is frequently used.Materials and methodsWe prospectively examined urine culture results collected from 334 RP patients immediately prior to catheter removal. Patients received prophylactic antibiotics 1 day before, the day of, and for 5 days after catheter removal. Culture results were reviewed for bacterial species and antimicrobial susceptibilities. Patients with positive urine cultures resistant to the prophylactic antibiotic were switched to culture-specific antibiotic therapy and underwent follow-up culture. The frequency of urinary tract infection (UTI), complications, additional antibiotic therapy, and repeat urine cultures was determined within 60 days.ResultsOf the 334 patients identified, 203 (61%) had cultures with no bacterial growth, and 48 (14%) had colony counts of <1,000 bacteria or Candida albicans and received no further antibiotics. The remaining 83 (25%) had positive culture results, of which 7% were resistant to ciprofloxacin. Twenty-four bacterial species were identified, with Pseudomonas aeruginosa (5%) Escherichia coli (4%), and Staphylococcus epidermidis (3%) being the most frequent. Only two (0.6%) men developed clinical symptoms consistent with UTI (i.e., suprapubic pain, fever) prior to catheter removal, and no serious complications occurred.ConclusionsA substantial proportion of RP patients have positive urine cultures at the time of catheter removal, despite the administration of prophylactic fluoroquinolone antibiotics. Potentially virulent organisms are commonly cultured, and ciprofloxacin resistance is frequent. However, outcomes are favorable when culture-specific oral antibiotic therapy is initiated.     

Efficacy of high-dose trimethoprim-sulfamethoxazol prophylaxis on early urinary tract infection after renal transplantation

Urinary tract infection (UTI), a major cause of morbidity in renal transplant recipients, has also been found to increase mortality. The first month post-kidney transplantation is considered the critical time, with most UTI episodes during this period. The aim of this study was to compare the efficacy of various doses of trimethoprim-sulfamethoxazole (TMP/SXT) for the prophylaxis of the posttransplant UTI within the first month after kidney transplantation. In a prospective, double-blind, randomized, clinical trial, 95 kidney allograft recipients were divided into two groups: group 1 (n = 63) received low to moderate doses of TMP/SXT (either 80/400 mg or 160/800 mg, daily) and group 2 (n = 32), high doses of TMP/SXT (320/1600 mg, daily in two divided doses). These groups were comparable regarding age, gender, type of donor, and ureteral anastomosis and immunosuppressive therapy. UTI was defined as a urine culture containing more than 10(5) colonies. The mean age of the patients was 37 +/- 12.2 years with a male/female ratio of 0.98/1. The urine culture was positive in 39 patients (41.1%). UTI was more common among female than male patients (P = .003). Escherichia coli was the most common isolated organism in both groups (53.8%). UTI was observed in about 25% of patients on the high-dose versus 49.2% of those on low- to moderate-dose prophylaxis (P < .05). In conclusion, prophylaxis with high-dose TMP/SXT (320/1600 mg, daily) is preferred for renal transplant recipients during the first month posttransplantation.     

Study of the local use of amikacin

Amikacin sulfate (AMK) was used against urinary tract infections (UTI) as local administration such as bladder lavage, renal pelvic lavage and vesical instillation. Forty four patients with UTI were treated by this method, 32 patients having Foley catheter indwelling in the bladder and 12 patients having drainage catheter indwelling in the renal pelvis. The overall clinical effect under UTI judgment was 3 excellent cases, 24 good, 11 fair and 6 poor, with an efficiency of 61.4%. A total of 100 bacteria, 47 gram positive, 33 gram negative, 6 anaerobes and 14 fungi, were found in the urine and bacteriological effect was 68.8% and 57.1% in single and combined bacterial infection, respectively. The serum concentration of AMK was measured in 9 patients by radioimmunoassay, and the maximum concentration was 0.38 micrograms/ml which is a low absorption rate. There were no adverse reactions during or after treatment with AMK.     

Management of Living Donor Liver Transplant Patients Using Twice-Daily 4-Hour Intravenous Cyclosporine Therapy

Oral administration of cyclosporine (CsA) is the currently favored route in most liver transplant centers. From October 1998 to January 2008, 86 living donor liver transplantations (LDLTs) were performed in 85 patients (46 adults and 39 children) at our institution. Seventy-three patients received tacrolimus (Tac), and 12 intravenous CsA twice daily at a dose of 3 mg/kg/d as a 4-hour continuous infusion. Thirteen of 73 Tac-based patients were switched to CsA because of side effects. Five were switched to intravenous CsA because they were unable to take the drug orally because of severe Tac-related complications. The remaining eight patients switched to oral CsA. We evaluated patients (11 adults and three children), including 12 with induction therapy and two with conversion therapy within 2 weeks of LDLT. The patients were given a 4-hour intravenous infusion of CsA at an initial dose of 3 mg/kg/d. Stable and adequate blood CsA concentrations were achieved by 4-hour intravenous CsA administration. Among several factors, only graft-to-recipient weight ratio (r = .743, P < .0001) showed significant correlations with initial blood CsA concentration. No adverse effects were observed after intravenous CsA. No patients developed biopsy-proven acute cellular rejection (ACR) during intravenous CsA administration, whereas two patients had histopathologically diagnosed episodes of ACR after conversion from intravenous to oral CsA. Our findings suggest that immediate administration of a 4-hour intravenous infusion of CsA at an initial dose of 3 mg/kg/d is practical and effective for routine clinical use.     

Clinical studies on combination chemotherapy with fosfomycin and dibekacin in complicated urinary tract infection

Clinical studies were performed on combination chemotherapy with Fosfomycin and Dibekacin. Sixteen patients with complicated urinary tract infections were treated with a combination of Fosfomycin (4 g/day, d.i.v.) and Dibekacin (200 mg/day, i.m.) for 5 days; and, 15 of them were clinically evaluated by criteria of UTI committee. The clinical effects proved excellent in 3 patients, good in 8 patients, and poor in 4 patients overall effective rate was 73.3%. Out of 19 strains isolated from the patients, 12 strains disappeared after the therapy. No side effect was observed in 16 cases. Clinical use of the combination chemotherapy with Fosfomycin and Dibekacin was thought to be effective and safe for patients with complicated urinary tract infections, because the combination acts not only synergistically, but also because Fosfomycin acts to protect against the nephrotoxicity induced by Dibekacin.     

Antibiotic resistance of urinary tract pathogens and rationale for empirical intravenous therapy

Empirical antibiotic treatment in urinary tract infection (UTI) in children must rely on surveillance data on the epidemiology and resistance patterns of common uropathogens. A retrospective analysis of bacteria isolated from children with UTI irrespective of underlying disease or pre-treatment was performed at the University Hospital of Freiburg, Germany, in 1997, and from 1999 to 2001. In the first study period, 261 positive urine samples and in the second period 684 positive samples were analyzed. Escherichia coli (57.2%) was the leading uropathogen followed by Enterococcus spp. (13.7%), Pseudomonas aeruginosa (7.0%), Proteus spp. (5.9%), Klebsiella spp. (4.7%), and Enterobacter/Citrobacter spp. (4.3%). Almost 50% of the E. coli isolates were resistant to ampicillin, but effectively no resistance against cephalosporins, aminogylcosides, ciprofloxacin, nitrofurantoin, and imipenem was observed. In Enterococcus spp. the resistance to ampicillin was about 15% and 40% to netilmicin, while none of the latter showed high-level aminoglycoside resistance. In P. aeruginosa, there was no resistance to aminoglycosides. No difference in resistance patterns between the two study periods was observed. We conclude that an empirical combination treatment of ampicillin and gentamicin, netilmicin, or tobramycin is appropriate in children with UTI independent of pre-treatment or underlying disease. This therapy should be clinically efficacious, well tolerated, and cost effective, and should prevent unnecessary development of antimicrobial resistance.     

Urinary tract infections and bacteriuria after gynecological surgery: Experience with 24-hour foley catheterization

The risks of urinary tract infection (UTI) and asymptomatic bacteriuria (AB) associated with short-term catheterization have not yet been established. A prospective observational study was carried out to determine the rates of UTI and AB when transurethral Foley catheterization was used for 24 hours. The study population was 193 women undergoing routine gynecologic surgery. All had negative preoperative urine cultures, and prohylactic antibiotics were not used.Postoperative UTI developed in 16 patients (8.3%), i.e. in only 14 of 86 with a positive culture on day 1 after surgery, and in 2 of 107 with a negative culture on day 1. These 16 women received antibiotics; 79 (40.9%) who had transient AB were not treated. There were no cases of upper UTI. Among 31 women discharged with AB, none developed UTI.Although 49.2% of patients in this study had postoperative bacteriuria as measured by midstream culture, only 8.3% of patients actually developed a symptomatic infection requiring treatment. As only a minority (11.3%) of patients with postoperative AB actually developed UTI, it appears that to treat all cases of bacteriuria >100 000 cfu/ml is unnecessary.     

The Effects of (L)-2-Oxothiazolidine-4-Carboxylate on Urinary Oxalate Excretion

Purpose

A phase I study was done to evaluate the safety and pharmacokinetics of (L)-2-oxothiazolidine-4-carboxylate (OTZ). An ancillary objective was to compare the effects of treatment with 2 levels of OTZ to placebo on urinary oxalate excretion in healthy male subjects.

Materials and Methods

Individuals underwent intravenous infusion of 70 (6) or 100 (6) mg./kg. body weight OTZ, or placebo for 2 hours at 4, 8-hour intervals. Urine was collected during the 12 hours before treatment, and at 0 to 4, 4 to 8, 8 to 24, 24 to 28, 28 to 32 and 32 to 48 hours after the initial infusion. Urine samples were assayed for creatinine, oxalate, citrate, sulfate, urate, phosphate and pH.

Results

Urinary oxalate excretion relative to creatinine decreased significantly in the 100 mg./kg. dose group by 4.1 mg./gm. during the first 24 hours and by 4.6 mg./gm. in 24 to 48 hours compared to baseline values (p <0.05). Slight decreases of 0.9 and 1.1 mg./gm., respectively, in the 70 mg./kg. dose group, and 1.6 and 2.3 mg./gm., respectively, in the placebo group were observed. Oxalate excretion on day 2 in the 100 mg./kg. dose group was significantly less than that in the placebo group (p = 0.04). Urinary pH decreased and sulfate excretion increased with OTZ therapy.

Conclusions

Treatment with 100 mg./kg. OTZ every 8 hours decreases urinary oxalate excretion in healthy men.     

Clinical efficacy of tosufloxacin on the patients with urinary tract infections]

We evaluated a newly developed quinolone agent, tosurofloxacin (TFLX), for its safety and clinical efficacy on patients with urinary tract infections (UTI). Among 138 cases satisfying the UTI criteria, 75 cases were acute simple UTI and 63 cases were chronic complicated UTI. In principle, a daily dose of 450 mg of TFLX was administered for 3 days and for 5 days for acute simple UTI and for chronic complicated UTI, respectively. Clinical efficacy of TFLX in these cases was evaluated according to the criteria of Japanese UTI committee. Bacteriologically, all 80 strains isolated from acute simple UTI were eradicated following TFLX administration. However, 2 gram positive strains and 1 gram negative strain, appeared following the treatment. In cases of chronic complicated UTI, 29 out of 32 gram positive strains and 29 out of 44 gram negative strains were eradicated. Among the isolated strains, P. aeruginosa and S. marcescens persisted, which suggests that they were less sensitive to TFLX. Overall clinical effectiveness rate of TFLX on acute simple UTI was 100%, while that on chronic complicated UTI was 73%. Adverse drug side effects were minimum, stomach discomfort and constipation was observed in one case each. These findings indicate that TFLX is a useful agent for the treatment of both simple and complicated UTI.     

Intermittent Catheterization and Recurrent Urinary Tract Infection in Spinal Cord Injury

Purpose:

To study the association of recurrent symptomatic urinary tract infections (UTIs) with the long-term use of clean intermittent catheterization (CIC) for the management of neurogenic bladder in patients with spinal cord injury (SCI).

Methods:

Retrospective study of 61 SCI patients with neurogenic bladder managed by CIC. Subjects were selected from 210 SCI patients seen at the Yale Urology Medical Group between 2000 and 2010. Medical UTI prophylaxis (PRx) with oral antimicrobials or methenamine/ascorbic acid was used to identify patients with recurrent UTI. The number of positive cultures (≥10³ cfu/mL) within a year prior to starting PRx was used to confirm the recurrence of UTI.

Results:

Fifty-one male and 10 female subjects were managed with CIC. Forty-one (67%) subjects were placed on medical PRx for symptomatic recurrent UTI. Seventeen (28%) subjects had at least 3 positive cultures within the year prior to starting PRx. Fifteen of 20 (75%) subjects not on PRx had no complaints of UTI symptoms in the final year of follow-up.

Conclusion:

Recurrent symptomatic UTIs remain a major complication of long-term CIC in SCI patients. Although CIC is believed to have the fewest number of complications, many SCI patients managed with long-term CIC are started on medical PRx early in the course of management. Future studies are needed to determine the efficacy of routine UTI PRx in these patients as well as determine what factors influence why many patients on CIC experience frequent infections and others do not.