Driven by increasing awareness of antibiotic stewardship, especially in the vulnerable group of patients with neurogenic lower urinary tract dysfunction (NLUTD), whose frequent need for invasive interventions leads to a high incidence of recurrent urinary tract infections (rUTIs), the goal was to find an alternative to antibiotic treatment. Our intention was for the treatment to be locally administered and well-tolerated as well as to avoid the risk of antimicrobial resistance.
A retrospective analysis of 12 catheterized NLUTD patients was performed within the setting of an individual curative trial. The decision to implement the investigational intervention was made on an individual basis with the aim of eliminating lower urinary tract bacteria before diagnostic procedures or to treat rUTI. Electrochemically activated solution (ECAS) was used as bladder irrigation (BI). The following assessments were undertaken: microbiological analysis of urine, analysis of leukocytes/erythrocytes (per µl urine); microbial resistance and sensitivity to antibiotics before and after therapy; clinical signs and patients' state of health.
Eradication of bacteria or an increase in microbial sensitivity to antibiotics was observed in 50%-70% of patients. No adverse events were seen. Due to the restrictions of an individual curative trial, the results are limited by the small number of patients and the absence of a control group.
In NLUTD patients with rUTIs, the use of ECAS BI to eliminate bacteriuria before invasive procedures (e.g., urodynamics, preoperative procedures) or to treat rUTI was shown to be a promising alternative to antibiotic treatment.
Neurourology and urodynamics. 2021 Jul 14 [Epub ahead of print]
Max Weyler, Anke Jaekel, Ruth Kirschner-Hermanns, Michael Kowollik, Federico Zeller, Stephanie Knuepfer
Department of Neuro-Urology, Clinic of Urology, University Hospital Bonn, Bonn, Germany., Neuro-Urology, Johanniter Neurological Rehabilitation Centre, Bonn, Germany.