Nonvalue of neomycin instillation after intermittent urinary catheterization

Area of Science:

• Urology
• Infectious Diseases
• Microbiology

Background:

• Neurogenic bladder disease often requires intermittent urinary catheterization for management.
• Preventing urinary tract infections (UTIs) is crucial in these patients.
• The efficacy of prophylactic intravesical antibiotics like neomycin in preventing UTIs requires evaluation.

Purpose of the Study:

• To assess the effectiveness of 0.1% neomycin instillations in preventing bacteriuria.
• To compare the incidence and types of UTIs in patients receiving neomycin versus a control group.

Main Methods:

• A prospective study comparing two groups of patients with neurogenic bladder undergoing intermittent catheterization.
• One group received weekly 0.1% neomycin instillations post-catheterization; the control group did not.
• Urine cultures were analyzed quantitatively to determine bacterial colony counts and identify pathogens.

Main Results:

• No significant difference in the overall incidence of bacteriuria was observed between the neomycin-treated group (53%) and the control group (49%).
• Most patients in both groups had significant bacteriuria (colony counts >10^5/ml).
• While Escherichia coli infections were less frequent in the neomycin group (43.4% vs. 62.5%), infections with Pseudomonas aeruginosa, group D streptococci, and yeasts were more common (41.5% vs. 22.5%).

Conclusions:

• Weekly intravesical neomycin instillations are not effective in reducing the overall incidence of bacteriuria in neurogenic bladder patients.
• Neomycin treatment may lead to a shift in the spectrum of urinary pathogens, favoring resistant organisms like Pseudomonas aeruginosa and yeasts.