Original Article
Spinal Cord (2009) 47, 565–569; doi:10.1038/sc.2008.166; published online 13 January 2009
A bacterial interference strategy for prevention of UTI in persons practicing intermittent catheterization
A Prasad1, M E Cevallos2,3, S Riosa2,3, R O Darouiche2,3,4 and B W Trautner2,3,4
- 1Department of Internal Medicine, New York Medical College-Westchester Medical Center, Westchester, NY, USA
- 2Division of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- 3Department of Physical Medicine and Rehabilitation, Center for Prosthesis Infection, Baylor College of Medicine, Houston, TX, USA
- 4The Michael E DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, TX, USA
Correspondence: Dr BW Trautner, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, BCM 286, N1319, Houston, TX 77030, USA. E-mail: trautner@bcm.edu
Received 18 September 2008; Revised 23 October 2008; Accepted 5 November 2008; Published online 13 January 2009.
Abstract
Study design:
Non-randomized pilot trial.
Objectives:
To determine whether Escherichia coli 83972-coated urinary catheters in persons with spinal cord injury (SCI) practicing an intermittent catheterization program (ICP) could (1) achieve bladder colonization with this benign organism and (2) decrease the rate of symptomatic urinary tract infection (UTI).
Setting:
Outpatient SCI clinic in a Veterans Affairs hospital (USA).
Methods:
Participants had neurogenic bladders secondary to SCI, were practicing ICP, had experienced at least one UTI and had documented bacteruria within the past year. All participants received a urinary catheter that had been pre-inoculated with E. coli 83972. The catheter was left in place for 3 days and then removed. Participants were followed with urine cultures and telephone calls weekly for 28 days and then monthly until E. coli 83972 was lost from the urine. Outcome measures were (1) the rate of successful bladder colonization, defined as the detection (
102 cfu ml-1) of E. coli 83972 in urine cultures for >3 days after catheter removal and (2) the rate of symptomatic UTI during colonization with E. coli 83972.
Results:
Thirteen participants underwent 19 insertions of study catheters. Eight participants (62%) became successfully colonized for >3 days after catheter removal. In these 8 participants, the rate of UTI during colonization was 0.77 per patient-year, in comparison with the rate of 2.27 UTI per patient-year before enrollment.
Conclusions:
E. coli 83972-coated urinary catheters are a viable means of achieving bladder colonization with this potentially protective strain in persons practicing ICP.
Keywords:
urinary tract infection, spinal cord injury, Escherichia coli
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