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Prospective study on the appearance of antibody-coated bacteria in patients with an indwelling urinary catheter
Abstract:
Elderly patients without urinary tract infection were given prophylactic medication with nitrofurantoin (NF) or methenamine hippurate (MH) because of need for an indwelling urinary catheter. Within 2 weeks of catheter use, all 31 controls without medication had significant bacteriuria; in the MH group (29 patients) 77% and in the NF group (26 patients) 58% were infected. Within 6 weeks virtually all the patients had bacteriuria. Antibody-coated bacteria (ACB) in the urine sediment were found in the minority of patients when bacteriuria first appeared; at 1 week, 50% of controls had ACB, whereas in the NF group this level of positively was reached after 3 weeks. However, by 5 weeks approximately 70% of patients in all groups had ACB. The mean time until ACB test positively after the appearance of bacteriuria was 1.7 weeks in the controls and 2.2 weeks in the MH group; in the NF group it was significantly longer (4.6 weeks). Prophylactic treatment of patient with an indwelling urinary catheter delayed the appearance of bacteriuria and ACB; however, their appearance could not be prevented even by NF.
Insights
Prophylactic nitrofurantoin (NF) or methenamine hippurate (MH) delayed but did not prevent bacteriuria in elderly patients with urinary catheters. Both treatments slowed the appearance of antibody-coated bacteria (ACB) in urine.
Area of Science:
- Urology
- Infectious Diseases
- Geriatrics
Background:
- Indwelling urinary catheters are associated with a high risk of bacteriuria in elderly patients.
- Prophylactic antimicrobial agents are sometimes used to prevent catheter-associated urinary tract infections (CAUTIs).
Purpose of the Study:
- To evaluate the efficacy of nitrofurantoin (NF) and methenamine hippurate (MH) in preventing bacteriuria and antibody-coated bacteria (ACB) in elderly patients requiring indwelling urinary catheters.
Main Methods:
- Elderly patients needing urinary catheters were randomized to receive prophylactic NF, MH, or no medication (controls).
- Bacteriuria and the presence of ACB in urine sediment were monitored over time.
Main Results:
- All control patients developed bacteriuria within 2 weeks; 77% of MH group and 58% of NF group also developed bacteriuria.
- Prophylactic treatment delayed the onset of bacteriuria and ACB detection.
- The mean time to ACB positivity after bacteriuria onset was significantly longer in the NF group (4.6 weeks) compared to controls (1.7 weeks) and MH group (2.2 weeks).
Conclusions:
- Prophylactic NF and MH can delay bacteriuria and ACB development in catheterized elderly patients.
- Neither agent completely prevented bacteriuria, indicating limitations in current prophylactic strategies.