Are prophylactic antibiotics necessary with clean intermittent catheterization? A randomized controlled trial
Section snippets
Patients and methods
One hundred twenty patients who used CIC were contacted. Eighty-five agreed to take part. The randomization was carried out using a random number table. The patients were randomly allocated into “group A” who would continue on antibiotics and “group B” who would not. Four patients were lost to follow-up and 28 were excluded as they did not comply with the randomization. The trial was to last 4 months. The outcome was clinical UTI. This we defined as the presence of more than 105 colony forming
Patient demographics
All patients fell under the care of a single consultant. Catheterization equipment consisted of polyvinyl chloride catheters coated with polyvinylpyrrolidone to obtain a low friction catheterization. The catheter size ranged between 8F to 16F (median, 10F). All patients had a diagnosis of neuropathic bladder and required CIC (median, 4 times a day). Eleven (35% ) of 31 in group A and 9 (40%) of 22 in group B were catheterizing via a Mitrofanoff. The primary pathology in most patients was spina
Results
There were 31 patients in group A (Fig. 1), of whom 11(36%) remained infection-free. Of this subgroup, 10 (91%) were self-catheterizing with 1 being catheterized by 2 or more people. Of the 20 (64%) who developed a clinical urine infection, 14 (70%) were not self-catheterizing. In the group who discontinued antibiotics, 19 (86%) remained infection-free for the entire trial. They were all self-catheterizing. Three (14%) patients did develop urine infection off antibiotics and were all
Discussion
Lapides reintroduced CIC in 1972. This revolutionized the management of neuropathic bladder [2], [3]. It was successfully applied to children with neuropathic bladders secondary to myelomeningocele [9].
The potential problems associated with in-dwelling and intermittent catheters are well described [4], [5], [10]. The periurethral area of children using CIC is colonized with enteric organisms presumed to have originated from the gastrointestinal tract. Bacteriuria is common and inevitable, as
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Cited by (46)
Risk Factors Associated With Recurrent Urinary Tract Infection in Neurogenic Bladders Managed by Clean Intermittent Catheterization
2017, UrologyCitation Excerpt :Antibiotic prophylaxis was not associated with a lower risk of frequent UTIs in this study, which is consistent with the contemporary literature of NB patients on CIC.22,23 In fact, some studies report an increased rate of UTI and risk of multidrug-resistant organisms in patients on antibiotic prophylaxis.24,25 Work from over 20 years ago suggested a significant reduction in the incidence and severity of symptomatic UTIs after bladder augmentation.26
Extended spectrum beta lactamase (ESBL) producing bacteria urinary tract infections and complex pediatric urology
2017, Journal of Pediatric SurgeryIntermittent catheterization in neurologic patients: Update on genitourinary tract infection and urethral trauma
2016, Annals of Physical and Rehabilitation MedicineCitation Excerpt :Although prophylactic antibiotic therapy has been reported to provide a significant but transient decrease in bacteriuria in this specific population, it should be avoided at all costs [27,28,44]. Indeed, such treatment was responsible for the selection and change in urinary bacteriuria leading to the emergence of multi-drug-resistant bacteria and increased incidence of urinary tract infection [44,45]. However, a novel approach, the Weekly Oral Prophylactic Antibiotic (WOPA), has recently been considered.
British Association of Paediatric Urologists consensus statement on the management of the neuropathic bladder
2016, Journal of Pediatric UrologyCitation Excerpt :The investigators concluded that in the absence of VUR, asymptomatic bacteriuria does not appear to be a significant risk factor for renal scarring and does not require antibiotic therapy. Studies examining the effect of antibiotic prophylaxis have found divergent results with respect to symptomatic infections – with a reduction of the rate in some [23] and more infections in other cohorts [24]. However, these studies do show that more resistant organisms are usually selected out by the prophylaxis [23,24].
Emergence of antimicrobial-resistant uropathogens isolated from pediatric patients with cystitis on daily clean intermittent catheterization
2015, Journal of Infection and ChemotherapyCitation Excerpt :But effect of prophylaxis in children with clean intermittent catheterization was controversial. Clarke et al. report that continuing prophylactic antibiotics increased rates of infection because of the development of resistant pathogens (continue prophylaxis: 64% versus discontinuation: 4%) [13]. Zegers et al. showed that discontinuation of antibiotic prophylaxis resulted in higher rates of afebrile urinary tract infection (incidence rate ratio: 1.44, 95% CI: 1.13–1.83, p = 0.003), and of 88 patients allocated to discontinuation of the prophylaxis switched chemoprophylaxis [14].