Role of neomycin polymyxin sulfate solution bladder wash for prevention of catheter associated urinary tract infection in traumatic brain injury patient admitted to Intensive Care Unit: A prospective randomized study

Abstract

Background:Catheter - associated urinary tract infection (CAUTI) remains a critical threat for patients in intensive care unit especially in traumatic brain injury patients with low Glasgow coma score (GCS). Almost all patients in ICU receive antibiotic either prophylactic or therapeutic based on local antibiogram of particular ICU or hospital. For prophylaxis, systemic antibiotics are used. It will be helpful to avoid systemic side effects by introducing antibiotics locally through bladder irrigation. The indwelling urinary catheter is an essential part of modern medical care.Aims and Objectives:The primary objective was to study the effect of Neomycin and Polymyxin sulphate solution for bladder wash on CAUTI in traumatic brain injury patients. The secondary objectives was to study the various organisms causing CAUTI and their antibiotic sensitivity and resistance pattern.Materials and Methods:This was a prospective randomized controlled study performed on 100 patients who met the inclusion criteria at the trauma intensive care unit of Banaras Hindu University between September and February 2016. The patients were randomized into two groups – one was the study group which received Neomycin and Polymyxin Sulphate solution bladder wash, while the other was the control group that received Normal saline bladder wash. Urine samples were collected at certain days and sent for culture and sensitivity.Results:There was significant reduction in the incidence of CAUTI in neomycin/polymyxin test group in comparison to normal saline irrigated control group. Out of 50 patients in test group 8 patients and in control group 26 patients was identified as CAUTI positive and they were statistically significant. In our study pseudomonas aeruginosa (51%) was the commonest isolated pathogen.Conclusions:Neomycin and Polymyxin Sulphate bladder wash was effective in preventing CAUTI. It can thus decrease the antibiotic usage thereby preventing the emergence of antibiotic resistance.

Polymyxins and Bacterial Membranes: A Review of Antibacterial Activity and Mechanisms of Resistance

“…Polymyxin B is used with bacitracin as an opthalmic ointment, while it is available with neomycin as a urinary bladder irrigant for short-term use (up to 10 days) in abacteriuric patients to help prevent bacteriuria and Gram-negative rod septicemia associated with the use of indwelling catheters. It is also available with both bacitracin and neomycin as a topical antibiotic [ 49 ]. Infections of the skin, mucous membranes, eye, and ear due to sensitive microorganisms respond to the local application of polymyxin B in solution or ointment form.…”

A Retrospective Analysis of Randomized Controlled Trials on Traumatic Brain Injury: Evaluation of CONSORT Item Adherence

“…For four studies, no impact factor of the publishing journal was listed [ 16 , 38 , 39 , 40 , 76 , 77 ]. Further, 11 articles were not available through the Web of Science database search at all [ 12 , 15 , 33 , 41 , 51 , 55 , 56 , 66 , 74 , 79 , 81 ]. Details on the studies, including specific interventions, number of patients and outcome measures, are attached as a Supplemental Data File .…”

Pilot Ex Vivo and In Vitro Evaluation of a Novel Foley Catheter with Antimicrobial Periurethral Irrigation for Prevention of Extraluminal Biofilm Colonization Leading to Catheter-Associated Urinary Tract Infections (CAUTIs)

“…Other interventions have been proposed for minimizing both extraluminal and intraluminal colonization pathways with conflicting reports and guidance for effectiveness in preventing CAUTI. e effectiveness of antimicrobial irrigation of the bladder followed by drainage had been contested in CDC guidelines [20] but more recently reported effective elsewhere [21,22]. Effectiveness of antimicrobial catheter coatings has similarly been reported to be inconclusive [23][24][25].…”