Bladder irrigation with povidone-iodine prevent recurrent urinary tract infections in neurogenic bladder patients on clean intermittent catheterization.
clean intermittent catheterization
intravesical instillation
neurogenic bladder
povidone-iodine
recurrent
urinary tract infection
Journal
Neurourology and urodynamics
ISSN: 1520-6777
Titre abrégé: Neurourol Urodyn
Pays: United States
ID NLM: 8303326
Informations de publication
Date de publication:
02 2021
02 2021
Historique:
received:
07
09
2020
revised:
24
12
2020
accepted:
04
01
2021
pubmed:
22
1
2021
medline:
23
6
2021
entrez:
21
1
2021
Statut:
ppublish
Résumé
To determine if daily povidone-iodine (PI) bladder irrigation in neurogenic lower urinary tract dysfunction (NLUTD) patients doing clean intermittent catheterization (CIC) can reduce the rate of symptomatic urinary tract infections (UTIs), emergency department (ED) visit for UTIs, and hospitalization for UTIs. We prospectively reviewed the records of patients with NLUTD on CIC who had recurrent symptomatic UTIs and who were placed on daily intravesical instillations of PI. This trial was conducted from January 2014 to January 2020 on 119 patients. After using daily PI bladder irrigation, the rate of symptomatic UTIs was reduced by 99.2% (incidence rate ratio [IRR]: 0.008, 95% confidence interval [CI]: 0.001-0.059; p < .001), the rate of ED visits was reduced by 99.2%% (IRR: 0.008, 95% CI: 0.001-0.059; p < .001), and the rate of inpatient hospitalizations for UTI was reduced by 99.9% (IRR: 0.0008, 95% CI: 0.0002-0.0035; p < .001). There was also a significant decrease in multidrug resistance in UTI organisms with the use of PI bladder instillation. Daily intravesical PI instillation is a well-tolerated approach to prevent UTIs and related ED visits and hospitalizations in NLUTD patients doing CIC.
Substances chimiques
Povidone-Iodine
85H0HZU99M
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
672-679Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2021 Wiley Periodicals LLC.
Références
Vigil HR, Hickling DR. Urinary tract infection in the neurogenic bladder. Transl Androl Urol. 2016;5(1):72-87.
Esclarín De Ruz A, García Leoni E, Herruzo, Cabrera R. Epidemiology and risk factors for urinary tract infection in patients with spinal cord injury. J Urol. 2000;164(4):1285-1289.
Saadat SH, Shepherd S, Van Asseldonk B, Elterman DS. Clean intermittent catheterization: single use vs. reuse. Can Urol Assoc J. 2019;13(2):64-69.
Mitsui T, Minami K, Furuno T, Morita H, Koyanagi T. Is suprapubic cystostomy an optimal urinary management in high quadriplegics? A comparative study of suprapubic cystostomy and clean intermittent catheterization. Eur Urol. 2000;38(4):434-438.
Mukai S, Shigemura K, Nomi M, et al. Retrospective study for risk factors for febrile UTI in spinal cord injury patients with routine concomitant intermittent catheterization in outpatient settings. Spinal Cord. 2016;54(1):69-72.
McKibben MJ, Seed P, Ross SS, Borawski KM. Urinary tract infection and neurogenic bladder. Urol Clin North Am. 2015;42(4):527-536.
Sauerwein D. Urinary tract infection in patients with neurogenic bladder dysfunction. Int J Antimicrob Agents. 2002;19(6):592-597.
Matsumoto T, Takahashi K, Manabe N, Iwatsubo E, Kawakami Y. Urinary tract infection in neurogenic bladder. Int J Antimicrob Agents. 2001;17(4):293-297.
Pannek J, Wöllner J. Management of urinary tract infections in patients with neurogenic bladder: challenges and solutions. Res Rep Urol. 2017;9:121-127.
Edokpolo LU, Stavris KB, Foster HE Jr. Intermittent catheterization and recurrent urinary tract infection in spinal cord injury. Top Spinal Cord Inj Rehabil. 2012;18(2):187-192.
Dray EV, Clemens JQ. Recurrent urinary tract infections in patients with incomplete bladder emptying: is there a role for intravesical therapy? Transl Androl Urol. 2017;6(suppl 2):S163-S170.
Wyndaele JJ, Brauner A, Geerlings SE, Bela K, Peter T, Bjerklund-Johanson TE. Clean intermittent catheterization and urinary tract infection: review and guide for future research. BJU Int. 2012;110(11 Pt C):E910-E917.
van den Broek PJ, Daha TJ, Mouton RP. Bladder irrigation with povidone-iodine in prevention of urinary-tract infections associated with intermittent urethral catheterisation. Lancet. 1985;1(8428):563-565.
Balsara ZR, Ross SS, Dolber PC, Wiener JS, Tang Y, Seed PC. Enhanced susceptibility to urinary tract infection in the spinal cord-injured host with neurogenic bladder. Infect Immun. 2013;81(8):3018-3026.
Lucas EJ, Baxter C, Singh C, et al. Comparison of the microbiological milieu of patients randomized to either hydrophilic or conventional PVC catheters for clean intermittent catheterization. J Pediatr Urol. 2016;12(3):172.e1-172.e8
Madero-Morales PA, Robles-Torres JI, Vizcarra-Mata G, et al. Randomized clinical trial using sterile single use and reused polyvinylchloride catheters for intermittent catheterization with a clean technique in spina bifida cases: short-term urinary tract infection outcomes. J Urol. 2019;202(1):153-158.
Huen KH, Nik-Ahd F, Chen L, Lerman S, Singer J. Neomycin-polymyxin or gentamicin bladder instillations decrease symptomatic urinary tract infections in neurogenic bladder patients on clean intermittent catheterization. J Pediatr Urol. 2019;15(2):178.e1-178.e7
Cox L, He C, Bevins J, Clemens JQ, Stoffel JT, Cameron AP. Gentamicin bladder instillations decrease symptomatic urinary tract infections in neurogenic bladder patients on intermittent catheterization. Can Urol Assoc J. 2017;11(9):E350-E354.
Haldorson AM, Keys TF, Maker MD, Opitz JL. Nonvalue of neomycin instillation after intermittent urinary catheterization. Antimicrob Agents Chemother. 1978;14(3):368-370.
Pearman JW. The value of kanamycin-colistin bladder instillations in reducing bacteriuria during intermittent catheterisation of patients with acute spinal cord injury. Br J Urol. 1979;51(5):367-374.
Wikström M, Levi R, Antepohl W. Bladder irrigation with chlorhexidine reduces bacteriuria in persons with spinal cord injury. J Rehabil Med. 2018;50(2):181-184.
Sharpe JR, Sadlowski RW, Finney RP, Halkias DG. Evaluation of povidone-iodine as vesical irrigant for treatment and prevention of urinary tract infections. Urology. 1981;17(4):335-338.
Tyagi P, Wu PC, Chancellor M, Yoshimura N, Huang L. Recent advances in intravesical drug/gene delivery. Mol Pharm. 2006;3(4):369-379.
Defoor W, Ferguson D, Mashni S, et al. Safety of gentamicin bladder irrigations in complex urological cases. J Urol. 2006;175(5):1861-1864.
de Jong TP, Donckerwolcke RA, Boemers TM. Neomycin toxicity in bladder irrigation. J Urol. 1993;150(4):1199.
Gerharz EW, Weingärtner K, Melekos MD, Varga S, Feiber H, Riedmiller H. Neomycin-induced perception deafness following bladder irrigation in patients with end-stage renal disease. Br J Urol. 1995;76(4):479-481.
Miller DP, Everett ED, Hamory BH, Haibach H, Durham JB, Kier-Schroeder A. Rat bladder irrigation with PVP-I2. J Urol. 1982;127(6):1230-1232.
Leung AM, Braverman LE. Consequences of excess iodine. Nat Rev Endocrinol. 2014;10(3):136-142.
Chundamala J, Wright JG. The efficacy and risks of using povidone-iodine irrigation to prevent surgical site infection: an evidence-based review. Can J Surg. 2007;50(6):473-481.