Portal de Periódicos da CAPES

The Challenge of Asymptomatic Bacteriuria and Symptomatic Urinary Tract Infections in Patients with Neurogenic Lower Urinary Tract Dysfunction

2019; Lippincott Williams & Wilkins; Volume: 203; Issue: 3 Linguagem: Inglês

10.1097/ju.0000000000000555

1527-3792

Jure Tornic, Jens Wöllner, Lorenz Leitner, Ulrich Mehnert, Lucas M. Bachmann, Thomas M. Kessler,

Pelvic floor disorders treatments

No AccessJournal of UrologyAdult Urology1 Mar 2020The Challenge of Asymptomatic Bacteriuria and Symptomatic Urinary Tract Infections in Patients with Neurogenic Lower Urinary Tract Dysfunction Jure Tornic, Jens Wöllner, Lorenz Leitner, Ulrich Mehnert, Lucas M. Bachmann, and Thomas M. Kessler Jure TornicJure Tornic Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland , Jens WöllnerJens Wöllner Neuro-Urology, Swiss Paraplegic Centre, Nottwil, Switzerland , Lorenz LeitnerLorenz Leitner Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland , Ulrich MehnertUlrich Mehnert Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland , Lucas M. BachmannLucas M. Bachmann Medignition Inc. Research Consultants, Zürich, Switzerland , and Thomas M. KesslerThomas M. Kessler †Correspondence: Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008Zürich , Switzerland telephone: +41 44 386 38 45; FAX: +41 44 386 39 09; E-mail Address: [email protected] Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland View All Author Informationhttps://doi.org/10.1097/JU.0000000000000555AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We investigated the prevalence of asymptomatic bacteriuria and the incidence of symptomatic urinary tract infections in patients with neurogenic lower urinary tract dysfunction undergoing urodynamics. We also assessed predictors of symptomatic urinary tract infections. Materials and Methods: We evaluated a prospective consecutive series of 317 patients, including 106 women and 211 men, with neurogenic lower urinary tract dysfunction. Of the patients 111 (35%) voided spontaneously, 141 (44%) relied on intermittent self-catheterization and 65 (21%) relied on an indwelling catheter. Before urodynamics the urine samples were collected by sterile catheterization for dipstick testing and urine culture. We assessed the association of patient characteristics with symptomatic urinary tract infections after urodynamics in patients with asymptomatic bacteriuria and developed a prediction model based on the most important risk factors. Results: Before urodynamics urine cultures were negative in 123 patients (39%) and positive in 194 (61%). Escherichia coli and Klebsiella pneumoniae were the most frequent bacteria, found in 32% and 18% of patients, respectively. Of 194 patients with a positive culture 35 (18%) had at least 1 symptomatic urinary tract infection. In patients with a history of previous urinary tract infections the overall estimated probability of a symptomatic urinary tract infection was 45% regardless of the underlying neurological disorder. Conclusions: A symptomatic urinary tract infection will develop in the followup year in about 1 of 5 patients with asymptomatic bacteriuria. This rather low overall probability precludes routine antibiotic prophylaxis or treatment in patients with neurogenic lower urinary tract dysfunction who have asymptomatic bacteriuria since 4 of 5 would be overtreated. However, in patients with a history of previous symptomatic urinary tract infections antibiotic prescription might be justified. References 1. : Lower urinary tract dysfunction in the neurological patient: clinical assessment and management. Lancet Neurol 2015; 14: 720. Google Scholar 2. : Summary of European Association of Urology (EAU) Guidelines on Neuro-Urology. Eur Urol 2016; 69: 324. Google Scholar 3. : Management of urinary tract infections in patients with neurogenic bladder: challenges and solutions. Res Rep Urol 2017; 9: 121. Google Scholar 4. : Antibiotic prophylaxis may not be necessary in patients with asymptomatic bacteriuria undergoing intradetrusor onabotulinumtoxinA injections for neurogenic detrusor overactivity. Sci Rep 2016; 6: 33197. Google Scholar 5. : EAU Guidelines on Urological Infections. Arnhem, The Netherlands: European Association of Urology Guidelines Office 2018. Google Scholar 6. : Benefits and harms of treatment of asymptomatic bacteriuria: a systematic review and meta-analysis by the European Association of Urology Urological Infection Guidelines Panel. Eur Urol 2017; 72: 865. Google Scholar 7. : Epidemiology and healthcare utilization of neurogenic bladder patients in a US claims database. Neurourol Urodyn 2011; 30: 395. Google Scholar 8. : Multicenter randomized controlled trial of bacterial interference for prevention of urinary tract infection in patients with neurogenic bladder. Urology 2011; 78: 341. Google Scholar 9. : Diagnostic criteria of urinary tract infection in male patients with spinal cord injury. Neurorehabil Neural Repair 2011; 25: 351. Google Scholar 10. : Results of urine culture and antimicrobial sensitivity tests according to the voiding method over 10 years in patients with spinal cord injury. Korean J Urol 2011; 52: 345. Google Scholar 11. : Bladder emptying method is the primary determinant of urinary tract infections in patients with spinal cord injury: results from a prospective rehabilitation cohort study. BJU Int 2019; 123: 342. Google Scholar 12. : Nitrite and leukocyte dipstick testing for urinary tract infection in individuals with spinal cord injury. J Spinal Cord Med 2004; 27: 128. Google Scholar 13. : Utility of urine reagent strip in screening women with incontinence for urinary tract infection. Int Urogynecol J Pelvic Floor Dysfunct 2004; 15: 391. Google Scholar 14. : Comparison of bacteria isolated from urinary tract infections in patients on transplant versus urologic wards. Transplant Proc 2011; 43: 3125. Google Scholar 15. : Current controversies in urinary tract infections: ICI-rs 2017. Neurourol Urodyn, suppl., 2018; 37: S86. Google Scholar 16. : Validity, accuracy, and predictive value of urinary tract infection signs and symptoms in individuals with spinal cord injury on intermittent catheterization. J Spinal Cord Med 2009; 32: 568. Google Scholar 17. : Antimicrobial resistance patterns in outpatient urinary tract infections—the constant need to revise prescribing habits. South Afr Med J 2011; 101: 328. Google Scholar 18. : Nonantibiotic prevention and management of recurrent urinary tract infection. Nat Rev Urol 2018; 15: 750. Google Scholar 19. : Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Am J Med, suppl., 2002; 113: 5S. Google Scholar 20. : Irrigation of continent catheterizable ileal pouches: tap water can replace sterile solutions because it is safe, easy, and economical. Eur Urol 2011; 59: 518. Google Scholar 21. : An implementation of next generation sequencing for prevention and diagnosis of urinary tract infection in urology. Can J Urol 2018; 25: 9349. Google Scholar 22. : Bacteriophages for treating urinary tract infections in patients undergoing transurethral resection of the prostate: a randomized, placebo-controlled, double-blind clinical trial. BMC Urol 2017; 17: 90. Google Scholar 23. : Adapted bacteriophages for treating urinary tract infections. Front Microbiol 2018; 9: 1832. Google Scholar 24. : Bacteriophages as potential treatment for urinary tract infections. Front Microbiol 2016; 7: 465. Google Scholar 25. : Probiotics for preventing urinary tract infection in people with neuropathic bladder. Cochrane Database Syst Rev 2017; 9: CD010723. Google Scholar 26. : Usefulness of classical homeopathy for the prophylaxis of recurrent urinary tract infections in individuals with chronic neurogenic lower urinary tract dysfunction. J Spinal Cord Med 2019; 42: 453. Google Scholar 27. : Effects of oral immunomodulation therapy on urinary tract infections in individuals with chronic spinal cord injury—a retrospective cohort study. Neurourol Urodyn 2019; 38: 346. Google Scholar 28. : Neuromodulation of urinary tract function. N Engl J Med 2019; 380: 2067. Google Scholar The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. Editor's Note: This article is the fourth of 5 published in this issue for which category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 627 and 628. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByGinsberg D, Boone T, Cameron A, Gousse A, Kaufman M, Keays E, Kennelly M, Lemack G, Rovner E, Souter L, Yang C and Kraus S (2021) The AUA/SUFU Guideline on Adult Neurogenic Lower Urinary Tract Dysfunction: Diagnosis and EvaluationJournal of Urology, VOL. 206, NO. 5, (1097-1105), Online publication date: 1-Nov-2021. Volume 203Issue 3March 2020Page: 579-584 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.Keywordsurinary bladderasymptomatic infectionsurinary tract infectionsneurogenicurodynamicsbacteriuriaMetricsAuthor Information Jure Tornic Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland Equal study contribution. More articles by this author Jens Wöllner Neuro-Urology, Swiss Paraplegic Centre, Nottwil, Switzerland Equal study contribution. More articles by this author Lorenz Leitner Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland More articles by this author Ulrich Mehnert Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland More articles by this author Lucas M. Bachmann Medignition Inc. Research Consultants, Zürich, Switzerland More articles by this author Thomas M. Kessler Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland †Correspondence: Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008Zürich , Switzerland telephone: +41 44 386 38 45; FAX: +41 44 386 39 09; E-mail Address: [email protected] More articles by this author Expand All The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. Editor's Note: This article is the fourth of 5 published in this issue for which category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 627 and 628. Advertisement Loading ...