Catheter-associated urinary tract infections in persons with neurogenic bladders

The Journal of Spinal Cord Medicine, 2018 · DOI: 10.1080/10790268.2017.1415419 · Published: April 1, 2018

Simple Explanation

Indwelling catheters are frequently used for bladder management after spinal cord injury, but they increase the risk of urinary tract infections. Preventing bladder overdistension and maintaining a healthy bacterial balance are crucial to minimize this risk. Judicious use of antibiotics is important because overuse can lead to antibiotic-resistant organisms. Alternative prevention and treatment strategies involve targeting the infection, modifying the bladder environment, and altering bacterial characteristics. New research suggests urine is not sterile and bladder colonization may play a role in preventing pathogenic bacteria from colonizing the bladder. The Human Microbiome Project found that each person has a unique microbiome.

Study Duration

Not specified

Participants

147 individuals with SCI in one study, 265 individuals with UTIs in another, 305 people with SCI with neurogenic bladder in another, 308 able-bodied women with history of recurrent UTIs in another. Also, a prospective evaluation of 147 individuals with SCI who came to the urology clinic because they felt they had a UTI.

Evidence Level

Review article

Key Findings

1
The incidence of UTI with indwelling urethral catheters was twice as high as for other types of management, emphasizing the importance of careful catheter management and judicious use of antibiotics in these individuals.
2
The accuracy of self-predicting a UTI was 61%; 39% were not accurate at predicting they had a UTI, regardless of the level of their injury.
3
Using expanded quantitative urine cultures, 80% grew bacterial species, showing that urine is not sterile.

Research Summary

Indwelling catheters play an important role in bladder management following SCI for many individuals with neurogenic bladders. Indwelling urethral catheters -but not SP catheters- pose an increased risk of UTI compared to other types of bladder management. Bacterial colonization of the bladder is common in those with both neurogenic and non-neurogenic bladders. This colonization likely has a positive effect by inhibiting colonization of pathogenic bacteria. Newer strategies under development to help prevent CAUTIs include “strengthening the host” with prebiotics/probiotics, blocking adhesions to the host/bladder urothelium, bacterial biofilm inhibition and immuno-biotherapy.

Practical Implications

Prudent Antibiotic Use

Emphasizes judicious antibiotic use to avoid resistance, considering alternative strategies.

Personalized Treatment Approaches

Highlights the importance of personalized treatment strategies due to the unique microbiome of each individual.

Targeted Prevention Strategies

Promotes targeted prevention by addressing bladder overdistension, maintaining a quiet bladder, and preventing bladder stones.

Study Limitations

1
Retrospective chart reviews make it difficult to determine whether the catheter caused the described complication.
2
The true incidence of complications from indwelling catheters is not known.
3
Further research is needed regarding the effects of probiotics, blocking bacterial adhesion to the bladder urothelium, inhibiting the formation of the bacterial biofilm and strengthening the immune system.

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