Bladder Irrigation or Irritation?

Elliott, T. S. J.; Reid, L. Corsan; Rao, G. Gopal; Rigby, Rebecca; Woodhouse, Ken

doi:10.1111/j.1464-410x.1989.tb06049.x

Cited by 56 publications

(28 citation statements)

References 13 publications

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“…After urinary catheterization, increased exfoliation or damage to the uroepithelium results in a denuded epithelium (9,12,17,18,28,33,44), a condition that does not efficiently support IBC formation, which is thought to occur only in terminally differentiated superficial umbrella cells. Thus, by day 5 after implantation of abacteriuric animals with a history of UTI, there is a significant reduction in bacterial bladder CFU compared to nonimplanted animals.…”

Section: Discussionmentioning

confidence: 99%

Combinatorial Small-Molecule Therapy Prevents Uropathogenic Escherichia coli Catheter-Associated Urinary Tract Infections in Mice

Guiton

Cusumano

Kline

et al. 2012

Antimicrob Agents Chemother

100

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ABSTRACTCatheter-associated urinary tract infections (CAUTIs) constitute the majority of nosocomial urinary tract infections (UTIs) and pose significant clinical challenges. These infections are polymicrobial in nature and are often associated with multidrug-resistant pathogens, including uropathogenicEscherichia coli(UPEC). Urinary catheterization elicits major histological and immunological alterations in the bladder that can favor microbial colonization and dissemination in the urinary tract. We report that these biological perturbations impact UPEC pathogenesis and that bacterial reservoirs established during a previous UPEC infection, in which bacteriuria had resolved, can serve as a nidus for subsequent urinary catheter colonization. Mannosides, small molecule inhibitors of the type 1 pilus adhesin, FimH, provided significant protection against UPEC CAUTI by preventing bacterial invasion and shifting the UPEC niche primarily to the extracellular milieu and on the foreign body. By doing so, mannosides potentiated the action of trimethoprim-sulfamethoxazole in the prevention and treatment of CAUTI. In this study, we provide novel insights into UPEC pathogenesis in the context of urinary catheterization, and demonstrate the efficacy of novel therapies that target critical mechanisms for this infection. Thus, we establish a proof-of-principle for the development of mannosides to prevent and eventually treat these infections in the face of rising antibiotic-resistant uropathogens.

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Section: Discussionmentioning

confidence: 99%

Combinatorial Small-Molecule Therapy Prevents Uropathogenic Escherichia coli Catheter-Associated Urinary Tract Infections in Mice

Guiton

Cusumano

Kline

et al. 2012

Antimicrob Agents Chemother

100

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“…There is an increased risk of infection from frequently breaking the closed drainage system; the problem of bacterial resistance; chemical cystitis may occur and mechanical damage to the bladder (from disruption of the mucosal cells and damage to the protecting mucous layer) may facilitate bacterial invasion into deeper mucosal layers. 51 For those patients with long-term indwelling catheters it is likely that the physical e ects of a washout may be more important than the action of any local antiseptic especially in controlling the formation of debris.…”

Section: Bladder Washouts or Instillationsmentioning

confidence: 99%

Prevention of urinary tract infection in patients with spinal cord injury – a microbiological review

Galloway

1997

Spinal Cord

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The importance of urinary tract infection (UTI) in patients with spinal cord injury cannot be understated. Many patients with signi®cant bacteriuria are considered to be colonised rather than infected, and treatment should be reserved for those with clinical symptoms or other signs of infection. 1 Published research on the prevention and management of UTI in patients with spinal cord injury often has limitations due to di erences in de®nitions of UTI, studies on groups using di erent urinary drainage appliances, the mixture of newly injured and longstanding injured patients and studies being carried out predominantly on male patients. 2 The complications due to UTI and the di culties in treating established infection mean that prevention is essential. Close urological follow-up is crucial in ensuring that adequate bladder drainage is achieved avoiding the use of long term indwelling urinary catheters if at all possible. 3 For those patients who require long term urinary appliances patient education and strict attention to hygiene and catheter care policies is important. The role of antiseptic/ antibiotics is strictly limited in preventing UTI in patients with spinal cord injury and may even be harmful. Further study into which groups of patients may bene®t from the use of antiseptics or antibiotics is urgently required. Continued research into di erent methods of prevention eg by vaccination, immunotherapy, the use of receptor analogues and bladder interference should also be encouraged.

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“…Moreover, there are no data on long-term follow-up of patients treated with intravesical aminoglycosides and one study suggested that it may disrupt the uroepithelium [25]. The duration of intravesical gentamicin treatment should therefore be determined based on an individual risk-benefit assessment.…”

Section: Page 13 Of 25mentioning

confidence: 99%

Intravesical gentamicin for recurrent urinary tract infection in patients with intermittent bladder catheterisation

Nieuwkoop

Exter

Elzevier

et al. 2010

International Journal of Antimicrobial Agents

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Clean intermittent catheterisation (CIC) of the bladder is used to imitate normal bladder emptying in patients with bladder dysfunction. CIC is associated with urinary tract infection (UTI) that may be difficult to treat in the case of antimicrobial resistance. The aim of this study was to establish the effect and safety of intravesical gentamicin treatment in such settings. In 2009, intravesical gentamicin treatment was started in selected patients. Here we describe our experience with two patients treated until March 2010. Two patients using CIC suffering recurrent UTI with multiresistant Escherichia coli were treated with daily administration of 80 mg intravesical gentamicin. On treatment they appeared asymptomatic. During 8-and 9-month follow-up they were free of UTI, urine cultures were negative and there were no side effects. A systematic review was conducted through searches of PubMed and other databases. Clinical trials that met the eligibility criteria and displayed the efficacy or safety of intravesical aminoglycoside treatment in patients using CIC were studied. Study selection was performed by two independent reviewers. Eight studies were included for review. Owing to study heterogeneity, a meta-analysis could not be performed. Of four controlled studies using neomycin or kanamycin, two demonstrated a significant reduction in bacteriuria, whilst two other trials did not. One case series on neomycin/polymyxin showed that the majority of patients still developed bacteriuria. Three case series using gentamicin all pointed towards a significant reduction in bacteriuria and UTIs. There were no clinically relevant side effects reported but follow-up in all studies was limited. Although data are limited, intravesical treatment with gentamicin might be a reasonable treatment option in selected patients practicing CIC who suffer recurrent UTIs with highly resistant microorganisms.

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Bladder Irrigation or Irritation?

Cited by 56 publications

References 13 publications

Combinatorial Small-Molecule Therapy Prevents Uropathogenic Escherichia coli Catheter-Associated Urinary Tract Infections in Mice

Combinatorial Small-Molecule Therapy Prevents Uropathogenic Escherichia coli Catheter-Associated Urinary Tract Infections in Mice

Prevention of urinary tract infection in patients with spinal cord injury – a microbiological review

Intravesical gentamicin for recurrent urinary tract infection in patients with intermittent bladder catheterisation

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