Prevention of urinary tract infections by antibiotic cycling in spinal cord injury patients and low emergence of multidrug resistant bacteria.
BACKGROUND
Urinary tract infections (UTIs) are a major recurrent problem for spinal cord injury (SCI) patients. Repeated antibiotic treatments contribute to the emergence of multidrug-resistant bacteria (MDRB). We evaluated the use of weekly oral cycling antibiotics (WOCA) in the prevention of UTIs over a mean follow-up period of 53 months (median follow-up period: 57 months) and analyzed the risk of MDRB emergence.


METHODS
We conducted a cross-sectional study of adult SCI patients with neurogenic bladder who were receiving the WOCA regimen.


RESULTS
We included 50 patients, mainly men (60%), with a mean age of 51±13.5 years. Overall, 66% of patients had been paraplegic or tetraplegic for 19.4±14.3 years; 92% underwent intermittent catheterization; and 36% had no postvoid residual. The number of febrile and non-febrile UTIs significantly reduced after WOCA initiation (9.45 non-febrile UTIs before WOCA initiation vs. 1.57 after; 2.25 febrile UTIs before WOCA initiation vs. 0.18 after; P=0.0001). Only one adverse event was reported during the follow-up period. The number of MDRB-colonized patients decreased from 9/50 to 4/50 during the follow-up period.


CONCLUSIONS
WOCA is an effective and safe strategy to prevent UTIs in SCI patients with neurogenic bladder. WOCA does not lead to the emergence of MDRB resistance and even seems to reduce MDRB carriage.
Service des maladies infectieuses, hôpital Bretonneau, université François-Rabelais, 37000 Tours, France. Electronic address: clpoirier@ch-dreux.fr.
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Poirier
Service de médecine aiguë spécialisée, hôpital R.-Poincaré, université de Versailles, 92380 Garches, France.
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Dinh
Service de médecine aiguë spécialisée, hôpital R.-Poincaré, université de Versailles, 92380 Garches, France.
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Salomon
Service de bactériologie, hôpital Bichat (Paris), université Paris Descartes, 75018 Paris, France.
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Grall
Service de bactériologie, hôpital Bichat (Paris), université Paris Descartes, 75018 Paris, France.
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Andremont
Service des maladies infectieuses, hôpital Bretonneau, université François-Rabelais, 37000 Tours, France.
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Bernard
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D003430:Cross-Sectional Studies; D024901:Drug Resistance, Multiple, Bacterial; D057915:Drug Substitution; D005260:Female; D005500:Follow-Up Studies; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D012007:Rectum / Q000382:microbiology; D013119:Spinal Cord Injuries / Q000150:complications*; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D001750:Urinary Bladder, Neurogenic / Q000150:complications / Q000628:therapy; D014546:Urinary Catheterization / Q000009:adverse effects; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*
D000900:Anti-Bacterial Agents
Antibiothérapie cyclique; Antibiotic cycling; Bactéries multirésistantes; Blessés médullaires; Infection urinaire; Multidrug resistant bacteria; Spinal cord injury; Urinary tract infection