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Antimicrobial prophylaxis for urinary tract infection in persons with spinal cord dysfunction
Sally C Morton1, Paul G Shekelle, John L Adams
1Southern California Evidence-Based Practice Center, Santa Monica, CA, USA. Sally_Morton@rand.org
Archives of Physical Medicine and Rehabilitation
|January 10, 2002
Summary
Antimicrobial prophylaxis does not significantly reduce symptomatic urinary tract infections (UTIs) in neurogenic bladder patients. However, it may reduce asymptomatic bacteriuria in acute cases but increases antimicrobial resistance.
Area of Science:
- Urology
- Infectious Diseases
- Neurology
Background:
- Neurogenic bladder, often resulting from spinal cord dysfunction, increases susceptibility to urinary tract infections (UTIs).
- Antimicrobial prophylaxis is a common strategy to prevent UTIs in these vulnerable patients.
Purpose of the Study:
- To evaluate the efficacy and safety of antimicrobial prophylaxis in preventing UTIs in individuals with neurogenic bladders due to spinal cord dysfunction.
Main Methods:
- A systematic review and meta-analysis of 15 randomized controlled trials involving adults and adolescents with neurogenic bladders.
- Searches were conducted across multiple databases (MEDLINE, EMBASE, CINAHL) with no language restrictions.
- Data on symptomatic UTIs, asymptomatic bacteriuria, and antimicrobial resistance were extracted and analyzed.
Main Results:
- Antimicrobial prophylaxis did not demonstrate a significant reduction in symptomatic UTIs.
- A statistically significant decrease in asymptomatic bacteriuria was observed in acute patients (within 90 days post-spinal cord injury).
- Prophylaxis was associated with a twofold increase in antimicrobial-resistant bacteria.
Conclusions:
- Routine antimicrobial prophylaxis is not recommended for most patients with neurogenic bladder secondary to spinal cord dysfunction.
- Further research, particularly randomized trials, is warranted for patients experiencing recurrent UTIs that impact daily life.