A bacterial interference strategy for prevention of UTI in persons practicing intermittent catheterization

Abstract

Study Design Non-randomized pilot trial Objectives Determine whether Escherichia coli 83972-coated urinary catheters in persons with spinal cord injury (SCI) practicing an intermittent catheterization program (ICP) could (1) achieve bladder colonization with this benign organism, and (2) decrease the rate of symptomatic urinary tract infection (UTI). Setting Outpatient SCI clinic in a Veterans Affairs hospital (USA) Methods Participants had neurogenic bladders secondary to SCI, were practicing ICP, had experienced at least 1 UTI, and had documented bacteruria within the past year. All subjects received a urinary catheter that had been pre-inoculated with E. coli 83972. The catheter was left in place for 3 days then removed. Subjects were followed with urine cultures and telephone calls weekly for 28 days and then monthly until E. coli 83972 was lost from the urine. Outcome measures were (1) the rate of successful bladder colonization, defined as the detection (≥102 cfu/ml) of E. coli 83972 in urine cultures for > 3 days after catheter removal and (2) the rate of symptomatic UTI while colonized with E. coli 83972. Results Thirteen subjects underwent 19 insertions of study catheters. Eight subjects (62%) became successfully colonized for > 3 days after catheter removal. In these 8 subjects, the rate of UTI while colonized was 0.77 per patient-year, in comparison to the rate of 2.27 UTI per patient-year prior to enrollment. Conclusions E. coli 83972-coated urinary catheters are a viable means to achieve bladder colonization with this potentially protective strain in persons practicing ICP.

Prevention of urinary tract infections in patients with spinal cord injury

“…This can be achieved using catheters that have been preinoculated with nonpathogenic bacteria. 6,36 Small observational trials have shown that patients whose bladders were successfully colonized with the nonpathogenic strains of Escherichia coli had a lower incidence of urinary tract infections than patients with noncolonized bladders. [36][37][38] An RCT compared inoculation of the bladder with a nonpathogenic E. coli 83972 strain to saline in 27 male patients with spinal cord injury.…”

“…6,36 Small observational trials have shown that patients whose bladders were successfully colonized with the nonpathogenic strains of Escherichia coli had a lower incidence of urinary tract infections than patients with noncolonized bladders. [36][37][38] An RCT compared inoculation of the bladder with a nonpathogenic E. coli 83972 strain to saline in 27 male patients with spinal cord injury. 37 All six participants in the placebo group had at least one urinary tract infection during the one-year follow-up period, compared with 13 of 21 participants (62%) in the experimental group (p = 0.07).…”

Preventing canine urinary tract infection (UTI) using an asymptomatic bacteriuria (ASB) Escherichia coli strain

“…This could be another factor to consider in the emergence of an increased number of refractory canine UTIs, with a shift towards faecal carriage of less susceptible organisms in some dogs (Mulvey et al, 2000;Johnson et al, 2001a;Prasad et al, 2009). Canine faecal deposits collected from a suburban neighbourhood were shown to contain E. coli strains with similar virulence traits and phylogenetic characteristics to human ExPEC, revealing that dogs may be common reservoirs of these organisms (Johnson et al, 2001a).…”

“…urine collection via cystocentesis, as urine samples collected in this manner are much less often contaminated with commensal bacteria of the skin and urogenital tract and faecal bacteria (Comer and Ling, 1981). Multidrug-resistance is increasingly observed in faecal E. coli (Mulvey et al, 2000;Johnson et al, 2001a;Prasad et al, 2009;Guo et al, 2013) and unintentional isolation of these organisms during the diagnostic workup for UTI may result in overuse of antimicrobials. …”

“…Escherichia coli 83972 has also been used to coat urinary catheters which were then retained for three days following urethral insertion (Prasad et al, 2009). The success rate for urine colonisation (≥3 days duration) using this method was 62%.…”