ICS 2018: The Impact of the Use of Vaccine Against Recurrent Urinary Tract Infections in Frail Elderly Patients

Philadelphia, PA (UroToday.com) Dr. Diaz and team presented this project focusing on the factors that are related to the presence of urinary tract infections (UTI) in frail hospitalized older adults.
They were aimed to improved measures in the management of recurrent UTI avoiding antibiotic prophylaxis by using polybacterial vaccine Uromune ®). Developed countries' populations tend to be aging. Antibiotic treatment may cause gastrointestinal disorders in elderly patients, in addition to increasing antibiotic-resistant microorganisms. This study shows the efficacy and benefit of the use of the polybacterial vaccine in this specific population.

This was a multicentric prospective study in institutionalized people diagnosed with recurrent urinary tract infections an alternative random assignment 1/1 successive to each group.

There were two groups

   - Group A (n = 50): patients receiving continuous low-dose antibiotic prophylaxis;
   - Group B (n = 50): patients receiving prophylaxis with a polybacterial vaccine (Uromune ®).

Age, gender, number of urinary tract infections, secondary diagnoses, concomitant treatments, health-related quality of life relative to UTI measured with a visual analog scale (VAS: 0 = worst, 10 = best) were analyzed.

Descriptive statistics, ANOVA, Student's t-test, Fisher's exact test, Pearson's correlation test was performed; p <0.05 was considered significant. They found that patients in the sample were 56 women (56%) and 44 men, which were equally distributed in both groups (Group A: 28 women and 22 men; Group B: 28 women and 22 men).

Regarding average age, no differences were found in the whole sample (women: 83.71 years; men: 80.17 years; p = 0.3112).  The mean number of urinary tract infections per year before prophylactic treatment: 8 (SD: 5.31).

At follow-up, the average number of urinary tract infection per month was higher in Group A (mean: 0.66, SD: 0.31) than in Group B (mean: 0.212, SD: 0.14) (p <0.0213).

There was no difference in the guiding symptom between groups (p = 1.0000): agitation (24.5%), dysuria (24.5%), disorientation/confusion (15.5%), hematuria (12.5%), malodorous urine (8.5%), general deterioration (4.5 %), decrease in consciousness (4.5%), oligosymptomatic (5.5%).

There were no differences between Group A and Group B found regarding Combur test results, urine culture or pre-intervention secondary diagnoses (p = 1.0000).

The number of urinary tract infections was related to constipation, urinary incontinence's severity, neurological disorders and renal failure.

 Average VAS was higher in Group B (mean: 7.1 SD: 0.55) with respect to Group A (mean 2.31, SD 0.87) (p <0.0001). The VAS was lower in cases of severe urinary incontinence / greater number of absorbents compared to other secondary diagnoses.

This vaccine favors immunoactive prophylaxis using a suspension of inactivated complete cells of different strains of Escherichia coli, Klebsiella pneumonia, Proteus mirabilis and Enterococcus faecalis. It is worth underlining that the sublingual administration of this vaccine is easy and comfortable, being practical for its use in institutionalized and dependent patients.

 The polyvalent bacterial vaccine is effective in the reduction of UTI against continuous low-dose antibiotic prophylaxis in frail institutionalized older adults and provides an improvement in the quality of life. Severe urinary incontinence, that requires the use of absorbents to a greater degree, worsens the management of UTIs in the frail institutionalized elderly.

Presented by: Bárbara Padilla-Fernández, MD, Department of Urology, Hospital Universitario de Canarias, Tenerife, Spain
Co-Authors: Lorenzo-Gómez M F1, González-Casado I3, De Dios-Hernández J M3, Blanco-Tarrío E3, Martínez-Huélamo M3, Núñez-Otero J J1, Hernández-Hernández D2, García-Cenador M B4, Castro-Díaz D M
Author Affiliation: 1. Department of Urology, Complejo Hospitalario Universitario de Salamanca, Salamanca, Spain, 2. Department of Urology, Hospital Universitario de Canarias, Tenerife, Spain, 3. Primary Healthcare, Complejo Hospitalario Universitario de Salamanca, Salamanca, Spain, 4. Department of Surgery, University of Salamanca, Salamanca, Spain

Written by: Bilal Farhan, MD; Clinical Instructor, Female Pelvic Medicine and Reconstructive Surgery, University of California, Irvine Medical Center, Twitter: @Bilalfarhan79 at the 2018 ICS International Continence Society Meeting - August 28 - 31, 2018 – Philadelphia, PA USA
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