Experiences of veterans with spinal cord injury related to annual urine screening and antibiotic use for urinary tract infections

Hines-Munson, Casey; May, Sarah; Poon, Ivy; Holmes, Sally Ann; Martin, Lindsey; Trautner, Barbara W.; Skelton, Felicia

doi:10.1002/pmrj.12568

Cited by 3 publications

(1 citation statement)

References 21 publications

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“…Our results shed light on the biofilm production phenotypes of E. coli strains isolated from the urine of patients with SCI, who frequently require chronic bladder catheterization ( Hines-Munson et al, 2021 ). Virtually all E. coli strains in our library formed biofilms.…”

Section: Discussionmentioning

confidence: 93%

Development of Phage Cocktails to Treat E. coli Catheter-Associated Urinary Tract Infection and Associated Biofilms

et al. 2022

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High rates of antimicrobial resistance and formation of biofilms makes treatment of Escherichia coli catheter-associated urinary tract infections (CAUTI) particularly challenging. CAUTI affect 1 million patients per year in the United States and are associated with morbidity and mortality, particularly as an etiology for sepsis. Phage have been proposed as a potential therapeutic option. Here, we report the development of phage cocktails that lyse contemporary E. coli strains isolated from the urine of patients with spinal cord injury (SCI) and display strong biofilm-forming properties. We characterized E. coli phage against biofilms in two in vitro CAUTI models. Biofilm viability was measured by an MTT assay that determines cell metabolic activity and by quantification of colony forming units. Nine phage decreased cell viability by >80% when added individually to biofilms of two E. coli strains in human urine. A phage cocktail comprising six phage lyses 82% of the strains in our E. coli library and is highly effective against young and old biofilms and against biofilms on silicon catheter materials. Using antibiotics together with our phage cocktail prevented or decreased emergence of E. coli resistant to phage in human urine. We created an anti-biofilm phage cocktail with broad host range against E. coli strains isolated from urine. These phage cocktails may have therapeutic potential against CAUTI.

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Section: Discussionmentioning

confidence: 93%

Development of Phage Cocktails to Treat E. coli Catheter-Associated Urinary Tract Infection and Associated Biofilms

et al. 2022

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Test Smart, Treat Smart‐using clinician feedback to adapt a catheter‐associated urinary tract infection intervention for spinal cord injury

Touchett,

Arredondo,

Hines‐Munson

et al. 2024

PM&R

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BackgroundCatheter‐associated urinary tract infection (CAUTI) prevention is a major target for hospital quality metrics because it is linked to increased morbidity, mortality, and health care costs. Health care systems use strict protocols surrounding catheterization and maintenance, which often disregard the clinical needs of special populations (eg, spinal cord injury [SCI]). However, for populations that rely on chronic instrumentation of the bladder, asymptomatic (ie, nonpathogenic) bacterial colonization in the bladder is common but not linked to adverse outcomes. Additionally, alterations in neurologic and sensory function after SCI make it difficult for clinicians to discern asymptomatic bacteriuria from acute urinary tract infection requiring antibiotics. Institutional policies for screening urine during SCI annual exams often lead to detection of bacteriuria but create a clinical decision‐making challenge when determining whether antibiotic treatment is appropriate.ObjectiveTo conduct preimplementation SCI‐focused adaptations to the evidence‐based practice (EBP) “Kicking CAUTI”—to develop a guide for SCI providers surrounding testing and treatment of CAUTI.MethodsFour 1‐hour focus groups were conducted with SCI clinicians (prescribers and nursing staff) to assess insights on needed modifications to adapt Kicking CAUTI for SCI. The Framework for Reporting Adaptations and Modifications to Evidence‐based Implementation Strategies (FRAME‐IS) was used to plan and report adaptations in this work and the integrated Promoting Action on Research Implementation in Health Services (i‐PARIHS) framework to guide adaptation of the EBP for the SCI population. Content and thematic analysis guided our process.ResultsThe clinical algorithm was simplified, a urinary symptom assessment added, and provider‐ and patient‐facing educational materials were developed to support implementation efforts to create the Test Smart Treat Smart Intervention.ConclusionsTraditional CAUTI protocols do not adequately address the needs of those with SCI and modifications are needed. Provider feedback provides valuable insights when adapting population appropriate interventions.

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Dual-directional regulation of spinal cord injury and the gut microbiota

Cui

Liu

et al. 2023

Neural Regeneration Research

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There is increasing evidence that the gut microbiota affects the incidence and progression of central nervous system diseases via the brain-gut axis. The spinal cord is a vital important part of the central nervous system; however, the underlying association between spinal cord injury and gut interactions remains unknown. Recent studies suggest that patients with spinal cord injury frequently experience intestinal dysfunction and gut dysbiosis. Alterations in the gut microbiota can cause disruption in the intestinal barrier and trigger neurogenic inflammatory responses which may impede recovery after spinal cord injury. This review summarizes existing clinical and basic research on the relationship between the gut microbiota and spinal cord injury. Our research identified three key points. First, the gut microbiota in patients with spinal cord injury presents a key characteristic and gut dysbiosis may profoundly influence multiple organs and systems in patients with spinal cord injury. Second, following spinal cord injury, weakened intestinal peristalsis, prolonged intestinal transport time, and immune dysfunction of the intestine caused by abnormal autonomic nerve function, as well as frequent antibiotic treatment, may induce gut dysbiosis. Third, the gut microbiota and associated metabolites may act on central neurons and affect recovery after spinal cord injury; cytokines and the Toll-like receptor ligand pathways have been identified as crucial mechanisms in the communication between the gut microbiota and central nervous system. Fecal microbiota transplantation, probiotics, dietary interventions, and other therapies have been shown to serve a neuroprotective role in spinal cord injury by modulating the gut microbiota. Therapies targeting the gut microbiota or associated metabolites are a promising approach to promote functional recovery and improve the complications of spinal cord injury.

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Experiences of veterans with spinal cord injury related to annual urine screening and antibiotic use for urinary tract infections

Cited by 3 publications

References 21 publications

Development of Phage Cocktails to Treat E. coli Catheter-Associated Urinary Tract Infection and Associated Biofilms

Development of Phage Cocktails to Treat E. coli Catheter-Associated Urinary Tract Infection and Associated Biofilms

Test Smart, Treat Smart‐using clinician feedback to adapt a catheter‐associated urinary tract infection intervention for spinal cord injury

Dual-directional regulation of spinal cord injury and the gut microbiota

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