Điều trị nhiễm trùng đường tiết niệu tái phát ở bệnh nhân có rối loạn chức năng bàng quang thần kinh

Julia Neuenschwander1, Jürgen Pannek1,2
1Neuro-Urologie, Schweizer Paraplegiker Zentrum, Nottwil, Schweiz
2Universitätsklinik für Urologie, Inselspital, Bern, Schweiz

Tóm tắt

Nhiễm trùng đường tiết niệu (HWI) là một trong những biến chứng phổ biến nhất ở bệnh nhân có rối loạn chức năng thần kinh của đường tiết niệu dưới. Chúng liên quan đến tỷ lệ bệnh tật, tử vong cao hơn và chất lượng cuộc sống kém hơn. Các yếu tố nguy cơ bao gồm chức năng bàng quang không được thiết lập tối ưu và việc sử dụng ống thông. Chỉ những nhiễm trùng có triệu chứng mới nên được điều trị, còn việc điều trị nhiễm khuẩn niệu không triệu chứng là không cần thiết, vì vậy việc sàng lọc không hợp lý. Các triệu chứng của một HWI có thể không đặc hiệu và khác với những người không có bệnh lý thần kinh nền. Trước khi bắt đầu điều trị, cần lấy mẫu nước tiểu để cấy và nên điều trị phù hợp với kháng sinh nếu có thể. HWI tái phát là phổ biến; việc dự phòng bằng kháng sinh nên được tránh tối đa do hiệu quả thấp và có khả năng tạo điều kiện cho vi khuẩn kháng thuốc đa kháng. Có nhiều phương pháp thay thế không kháng sinh; tuy nhiên, vì không có giúp chứng minh hiệu quả dựa trên bằng chứng cho bất kỳ phương pháp nào, cần có cách tiếp cận cá nhân hóa với điều chỉnh biện pháp dự phòng theo diễn biến lâm sàng.

Từ khóa

#nhiễm trùng đường tiết niệu #rối loạn chức năng bàng quang #điều trị #kháng sinh #phòng ngừa

Tài liệu tham khảo

Esclarin De Ruz A, Garcia Leoni E, Herruzo Cabrera R (2000) Epidemiology and risk factors for urinary tract infection in patients with spinal cord injury. J Urol 164:1285–1289 Biering-Sorensen F, Nielans HM, Dorflinger T, Sorensen B (1999) Urological situation five years after spinal cord injury. Scand J Urol Nephrol 33:157–161 Biering-Sorensen F, Bagi P, Hoiby N (2001) Urinary tract infections in patients with spinal cord lesions: treatment and prevention. Drugs 61:1275–1287 Hinkel A, Finke W, Botel U, Gatermann SG, Pannek J (2004) Increasing resistance against antibiotics in bacteria isolated from the lower urinary tract of an outpatient population of spinal cord injury patients. Urol Int 73:143–148 Goble NM, Clarke T, Hammonds JC (1989) Histological changes in the urinary bladder secondary to urethral catheterisation. Br J Urol 63:354–357 Glahn BE, Braendstrup O, Olesen HP (1988) Influence of drainage conditions on mucosal bladder damage by indwelling catheters. II. Histological study. Scand J Urol Nephrol 22:93–99 Delnay KM, Stonehill WH, Goldman H, Jukkola AF, Dmochowski RR (1999) Bladder histological changes associated with chronic indwelling urinary catheter. J Urol 161:1106–1108 (discussion 8–9) Warren JW (2001) Catheter-associated urinary tract infections. Int J Antimicrob Agents 17:299–303 Brommer B, Engel O, Kopp MA et al (2016) Spinal cord injury-induced immune deficiency syndrome enhances infection susceptibility dependent on lesion level. Brain 139:692–707 Lucin KM, Sanders VM, Jones TB, Malarkey WB, Popovich PG (2007) Impaired antibody synthesis after spinal cord injury is level dependent and is due to sympathetic nervous system dysregulation. Exp Neurol 207:75–84 Hong J, Chang A, Liu Y, Wang J, Fehlings MG (2019) Incomplete spinal cord injury reverses the level-dependence of spinal cord injury immune deficiency syndrome. Int J Mol Sci 1:20 EAU (2020) EAU Guidelines. EAU Annual Congress, Amsterdam. ISBN 978-94-92671-07‑3 Goetz LL, Cardenas DD, Kennelly M et al (2013) International spinal cord injury urinary tract infection basic data set. Spinal Cord 51:700–704 Hoffman JM, Wadhwani R, Kelly E, Dixit B, Cardenas DD (2004) Nitrite and leukocyte dipstick testing for urinary tract infection in individuals with spinal cord injury. J Spinal Cord Med 27:128–132 Mukai S, Shigemura K, Nomi M et al (2016) Retrospective study for risk factors for febrile UTI in spinal cord injury patients with routine concomitant intermittent catheterization in outpatient settings. Spinal Cord 54:69–72 Anderson CE, Chamberlain JD, Jordan X et al (2019) Bladder emptying method is the primary determinant of urinary tract infections in patients with spinal cord injury: results from a prospective rehabilitation cohort study. BJU Int 123:342–352 Krebs J, Wollner J, Pannek J (2016) Risk factors for symptomatic urinary tract infections in individuals with chronic neurogenic lower urinary tract dysfunction. Spinal Cord 54:682–686 Nicolle LE (2014) Catheter associated urinary tract infections. Antimicrob Resist Infect Control 3:23 Farrelly E, Lindbo L, Wijkstrom H, Seiger A (2020) The Stockholm Spinal Cord Uro Study: 2. Urinary tract infections in a regional prevalence group: frequency, symptoms and treatment strategies. Scand J Urol 54:155–161 Shigemura K, Kitagawa K, Nomi M, Yanagiuchi A, Sengoku A, Fujisawa M (2020) Risk factors for febrile genito-urinary infection in the catheterized patients by with spinal cord injury-associated chronic neurogenic lower urinary tract dysfunction evaluated by urodynamic study and cystography: a retrospective study. World J Urol 38:733–740 Everaert K, Lumen N, Kerckhaert W, Willaert P, van Driel M (2009) Urinary tract infections in spinal cord injury: prevention and treatment guidelines. Acta Clin Belg 64:335–340 Hooton TM, Bradley SF, Cardenas DD et al (2010) Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis 1(50):625–663 Clark R, Welk B (2018) The ability of prior urinary cultures results to predict future culture results in neurogenic bladder patients. Neurourol Urodyn 37:2645–2650 Pannek J, Pannek-Rademacher S, Wollner J (2018) Treatment of complicated urinary tract infections in individuals with chronic Neurogenic lower urinary tract dysfunction: are antibiotics mandatory? Urol Int 100:434–439 Del Popolo G, Nelli F (2018) Recurrent bacterial symptomatic cystitis: A pilot study on a new natural option for treatment. Archivio italiano di urologia, andrologia 30(90):101–103 Pannek J, Pannek-Rademacher S, Cachin-Jus M (2014) Organ-preserving treatment of an epididymal abscess in a patient with spinal cord injury. Spinal Cord 52(Suppl 1):7–8 Kumazawa J, Matsumoto T (1992) The dipstick test in the diagnosis of UTI and the effect of pretreatment catheter exchange in catheter-associated UTI. Infection 20(Suppl 3):S157–9 DeFoor W, Reddy P, Reed M et al (2017) Results of a prospective randomized control trial comparing hydrophilic to uncoated catheters in children with neurogenic bladder. J Pediatr Urol 13(373):e1–e5 Lucas EJ, Baxter C, Singh C et al (2016) Comparison of the microbiological milieu of patients randomized to either hydrophilic or conventional PVC catheters for clean intermittent catheterization. J Pediatr Urol 12(172):e1–8 Christensen P, Bazzocchi G, Coggrave M et al (2006) A randomized, controlled trial of transanal irrigation versus conservative bowel management in spinal cord-injured patients. Gastroenterology 131:738–747 Emmanuel A, Kumar G, Christensen P et al (2016) Long-term cost-effectiveness of transanal irrigation in patients with neurogenic bowel dysfunction. PLoS ONE 11:e159394 Lee BB, Haran MJ, Hunt LM et al (2007) Spinal-injured neuropathic bladder antisepsis (SINBA) trial. Spinal Cord 45:542–550 Günther M, Noll F, Nützel R, Gläser E, Kramer G, Stöhrer M (2002) Harnwegsinfektprophylaxe. Urologe B 42(3):218–220 Ditscheid B, Funfstuck R, Busch M et al (2005) Effect of L‑methionine supplementation on plasma homocysteine and other free amino acids: a placebo-controlled double-blind cross-over study. Eur J Clin Nutr 59:768–775 Stanger O, Herrmann W, Pietrzik K et al (2003) DACH-LIGA homocystein (german, austrian and swiss homocysteine society): consensus paper on the rational clinical use of homocysteine, folic acid and B‑vitamins in cardiovascular and thrombotic diseases: guidelines and recommendations. Clin Chem Lab Med 41:1392–1403 Krebs J, Fleischli S, Stoyanov J, Pannek J (2019) Effects of oral immunomodulation therapy on urinary tract infections in individuals with chronic spinal cord injury—A retrospective cohort study. Neurourol Urodyn 38:346–352 Hachen HJ (1990) Oral immunotherapy in paraplegic patients with chronic urinary tract infections: a double-blind, placebo-controlled trial. J Urol 143:759–762 (discussion 62–3) Huttner A, Hatz C, van den Dobbelsteen G et al (2017) Safety, immunogenicity, and preliminary clinical efficacy of a vaccine against extraintestinal pathogenic Escherichia coli in women with a history of recurrent urinary tract infection: a randomised, single-blind, placebo-controlled phase 1b trial. Lancet Infect Dis 17:528–537 (May) Sunden F, Hakansson L, Ljunggren E, Wullt B (2010) Escherichia coli 83972 bacteriuria protects against recurrent lower urinary tract infections in patients with incomplete bladder emptying. J Urol 184:179–185 Darouiche RO, Green BG, Donovan WH et al (2011) Multicenter randomized controlled trial of bacterial interference for prevention of urinary tract infection in patients with neurogenic bladder. Urology 78:341–346 Toh SL, Boswell-Ruys CL, Lee BSB, Simpson JM, Clezy KR (2017) Probiotics for preventing urinary tract infection in people with neuropathic bladder. Cochrane Database Syst Rev 9:Cd10723 Pannek J, Pannek-Rademacher S, Wollner J (2015) Use of complementary and alternative medicine in persons with spinal cord injury in Switzerland: a survey study. Spinal Cord 53:569–572 Jonas WB, Kaptchuk TJ, Linde K (2003) A critical overview of homeopathy. Ann Intern Med 4(138):393–399 Pannek J, Pannek-Rademacher S, Jus MS et al (2019) Usefulness of classical homeopathy for the prophylaxis of recurrent urinary tract infections in individuals with chronic neurogenic lower urinary tract dysfunction. J Spinal Cord Med 42:453–459 Wang J, Zhai Y, Wu J, Zhao S, Zhou J, Liu Z (2016) Acupuncture for chronic urinary retention due to spinal Cord injury: a systematic review. Evid Based Complement Alternat Med 2016:9245186 Honjo H, Naya Y, Ukimura O, Kojima M, Miki T (2000) Acupuncture on clinical symptoms and urodynamic measurements in spinal-cord-injured patients with detrusor hyperreflexia. Urol Int 65:190–195 Aune A, Alraek T, LiHua H, Baerheim A (1998) Acupuncture in the prophylaxis of recurrent lower urinary tract infection in adult women. Scand J Prim Health Care 16:37–39 Alraek T, Baerheim A, Birch S (2016) Acupuncture points used in the prophylaxis against recurrent uncomplicated cystitis, patterns identified and their possible relationship to physiological measurements. Chin J Integr Med 22:510–517 Azeredo J, Sutherland IW (2008) The use of phages for the removal of infectious biofilms. Curr Pharm Biotechnol 9:261–266 Viertel TM, Ritter K, Horz HP (2014) Viruses versus bacteria-novel approaches to phage therapy as a tool against multidrug-resistant pathogens. J Antimicrob Chemother 69:2326–2336 Gu J, Liu X, Li Y et al (2012) A method for generation phage cocktail with great therapeutic potential. PLoS ONE 7:e31698 Khawaldeh A, Morales S, Dillon B et al (2011) Bacteriophage therapy for refractory Pseudomonas aeruginosa urinary tract infection. J Med Microbiol 60:1697–1700 Leitner L, Ujmajuridze A, Chanishvili N et al (2021) Intravesical bacteriophages for treating urinary tract infections in patients undergoing transurethral resection of the prostate: a randomised, placebo-controlled, double-blind clinical trial. Lancet Infect Dis 21:427–436 Abrams P, Hashim H, Tomson C et al (2017) The use of intravesical gentamicin to treat recurrent urinary tract infections in lower urinary tract dysfunction. Neurourol Urodyn 36:2109–2116 Cox L, He C, Bevins J, Clemens JQ, Stoffel JT, Cameron AP (2017) Gentamicin bladder instillations decrease symptomatic urinary tract infections in neurogenic bladder patients on intermittent catheterization. Can Urol Assoc J 11:E350–e4 Iavazzo C, Athanasiou S, Pitsouni E, Falagas ME (2007) Hyaluronic acid: an effective alternative treatment of interstitial cystitis, recurrent urinary tract infections, and hemorrhagic cystitis? Eur Urol 51:1534–1540 (discussion 40–1) Damiano R, Quarto G, Bava I et al (2011) Prevention of recurrent urinary tract infections by intravesical administration of hyaluronic acid and chondroitin sulphate: a placebo-controlled randomised trial. Eur Urol 59:645–651 Cicek N, Yildiz N, Alpay H (2020) Intravesical hyaluronic acid treatment in recurrent urinary tract infections in children with spina bifida and neurogenic bladder. J Pediatr Urol 16(366):e1–e5 Niël-Weise BS, van den Broek PJ (2005) Urinary catheter policies for long-term bladder drainage. Cochrane Database Syst Rev 25:Cd4201 Fisher H, Oluboyede Y, Chadwick T et al (2018) Continuous low-dose antibiotic prophylaxis for adults with repeated urinary tract infections (AnTIC): a randomised, open-label trial. Lancet Infect Dis 18:957–968 Poirier C, Dinh A, Salomon J, Grall N, Andremont A, Bernard L (2016) Prevention of urinary tract infections by antibiotic cycling in spinal cord injury patients and low emergence of multidrug resistant bacteria. Med Mal Infect 46:294–299 Salomon J, Denys P, Merle C et al (2006) Prevention of urinary tract infection in spinal cord-injured patients: safety and efficacy of a weekly oral cyclic antibiotic (WOCA) programme with a 2 year follow-up—an observational prospective study. J Antimicrob Chemother 57:784–788 Dinh A, Hallouin-Bernard MC, Davido B et al (2020) Weekly sequential antibioprophylaxis for recurrent urinary tract infections among patients with neurogenic bladder: a randomized controlled trial. Clin Infect Dis 15(71):3128–3135 Salomon J, Schnitzler A, Ville Y et al (2009) Prevention of urinary tract infection in six spinal cord-injured pregnant women who gave birth to seven children under a weekly oral cyclic antibiotic program. Int J Infect Dis 13:399–402 Michau A, Dinh A, Denys P et al (2016) Control cross-sectional study evaluating an antibiotic prevention strategy in 30 pregnancies under clean intermittent self-catheterization and review of literature. Urology 91:58–63 Galusca N, Charvier K, Courtois F, Rode G, Rudigoz RC, Ruffion A (2015) Antibioprophylaxy and urological management of women with spinal cord injury during pregnanc. Prog Urol 25:489–496 Böthig R, Fiebag K, Thietje R, Faschingbauer M, Hirschfeld S (2013) Morbidity of urinary tract infection after urodynamic examination of hospitalized SCI patients: the impact of bladder management. Spinal Cord 51:70–73 Tornic J, Wöllner J, Leitner L, Mehnert U, Bachmann LM, Kessler TM (2020) The challenge of asymptomatic Bacteriuria and symptomatic urinary tract infections in patients with neurogenic lower urinary tract dysfunction. J Urol 203:579–584 Aharony S, Przydacz M, Van Ba OL, Corcos J (2020) Does asymptomatic bacteriuria increase the risk of adverse events or modify the efficacy of intradetrusor onabotulinumtoxinA injections? Neurourol Urodyn 39:203–210 Leitner L, Sammer U, Walter M et al (2016) Antibiotic prophylaxis may not be necessary in patients with asymptomatic bacteriuria undergoing intradetrusor onabotulinumtoxin A injections for neurogenic detrusor overactivity. Sci Rep 12(6):33197 Weglinski L, Rouzaud C, Even A et al (2016) Prospective evaluation of antibiotic treatment for urological procedure in patients presenting with neurogenic bladder. Med Mal Infect 46:300–307 Chong JT, Klausner AP, Petrossian A et al (2015) Pre-procedural antibiotics for endoscopic urological procedures: Initial experience in individuals with spinal cord injury and asymptomatic bacteriuria. J Spinal Cord Med 38:187–192 Paradella AC, Musegante AF, Brites C (2016) Comparison of different antibiotic protocols for asymptomatic bacteriuria in patients with neurogenic bladder treated with botulinum toxin A. Braz J Infect Dis 20:623–626