Skip to main content
SpringerLink
Log in

Behandlung rezidivierender Harnwegsinfekte bei PatientInnen mit neurogener Blasenfunktionsstörung

Treatment of recurrent urinary tract infections in patients with neurogenic bladder dysfunction

  • Originalien
  • Published:
Journal für Urologie und Urogynäkologie/Österreich Aims and scope

Zusammenfassung

Harnwegsinfekte (HWI) gehören zu den häufigsten Komplikationen bei PatientInnen mit neurogener Funktionsstörung des unteren Harntrakts. Sie sind mit einer erhöhten Morbidität, Mortalität und einer verschlechterten Lebensqualität assoziiert. Zu den Risikofaktoren gehören eine suboptimal eingestellte Blasenfunktion und die Verwendung von Kathetern. Nur symptomatische Infekte sollten behandelt werden, die Therapie einer asymptomatischen Bakteriurie ist nicht indiziert, und somit ist ein Screening nicht sinnvoll. Die Symptome eines HWI können unspezifisch und anders als bei Personen ohne neurologische Grunderkrankung sein. Vor Therapiebeginn sollte eine Urinkultur angelegt werden, und es sollte, wenn immer möglich, resistenzgerecht therapiert werden. Rezidivierende HWI sind häufig; eine antibiotische Prophylaxe sollte wegen der geringen Effektivität und der Begünstigung multiresistenter Keime möglichst vermieden werden. Es existieren verschiedene nichtantibiotische Alternativen; da jedoch für kein Verfahren ein evidenzbasierter Wirknachweis besteht, ist ein individuelles Vorgehen mit Modifikation der Prophylaxe nach klinischem Verlauf erforderlich.

Summary

Urinary tract infections (UTIs) are one of the most common complications in patients with neurogenic dysfunction of the lower urinary tract. They are associated with higher morbidity and mortality, as well as with a poorer quality of life. The risk factors include a suboptimally stabilised bladder function and the use of catheters. Only symptomatic infections should be treated. Therapy for asymptomatic bacteriuria is not indicated, so that screening has no purpose here. The symptoms of a UTI can be non-specific and may differ from those of persons without any underlying neurological disease. A urine culture should be performed before the start of treatment and, whenever possible, appropriate resistance-based therapy administered accordingly. Recurrent UTIs are common; antibiotic prophylaxis should be avoided as far as possible due to its insignificant effect and role in encouraging multidrug-resistant bacteria. Various non-antibiotic alternatives are available here. However, as there is no evidence-based proof of efficacy for any option, it is necessary to take an individual approach with modification of the prophylaxis depending on the clinical course.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. 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

    Article  CAS  PubMed  Google Scholar 

  2. 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

    Article  CAS  PubMed  Google Scholar 

  3. Biering-Sorensen F, Bagi P, Hoiby N (2001) Urinary tract infections in patients with spinal cord lesions: treatment and prevention. Drugs 61:1275–1287

    Article  CAS  PubMed  Google Scholar 

  4. 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

    Article  CAS  PubMed  Google Scholar 

  5. Goble NM, Clarke T, Hammonds JC (1989) Histological changes in the urinary bladder secondary to urethral catheterisation. Br J Urol 63:354–357

    Article  CAS  PubMed  Google Scholar 

  6. 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

    Article  CAS  PubMed  Google Scholar 

  7. 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)

    Article  CAS  PubMed  Google Scholar 

  8. Warren JW (2001) Catheter-associated urinary tract infections. Int J Antimicrob Agents 17:299–303

    Article  CAS  PubMed  Google Scholar 

  9. 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

    Article  PubMed  PubMed Central  Google Scholar 

  10. 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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. 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

    Google Scholar 

  12. EAU (2020) EAU Guidelines. EAU Annual Congress, Amsterdam. ISBN 978-94-92671-07‑3

    Google Scholar 

  13. Goetz LL, Cardenas DD, Kennelly M et al (2013) International spinal cord injury urinary tract infection basic data set. Spinal Cord 51:700–704

    Article  CAS  PubMed  Google Scholar 

  14. 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

    Article  PubMed  Google Scholar 

  15. 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

    Article  CAS  PubMed  Google Scholar 

  16. 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

    Article  PubMed  Google Scholar 

  17. 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

    Article  CAS  PubMed  Google Scholar 

  18. Nicolle LE (2014) Catheter associated urinary tract infections. Antimicrob Resist Infect Control 3:23

    Article  PubMed  PubMed Central  Google Scholar 

  19. 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

    Article  PubMed  Google Scholar 

  20. 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

    Article  CAS  PubMed  Google Scholar 

  21. 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

    Article  CAS  PubMed  Google Scholar 

  22. 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

    Article  Google Scholar 

  23. 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

    Article  CAS  PubMed  Google Scholar 

  24. 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

    Article  PubMed  Google Scholar 

  25. 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

    Article  CAS  Google Scholar 

  26. 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

    Article  Google Scholar 

  27. 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

    Article  PubMed  Google Scholar 

  28. 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

    Google Scholar 

  29. 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

    Google Scholar 

  30. 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

    Article  PubMed  Google Scholar 

  31. 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

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  32. Lee BB, Haran MJ, Hunt LM et al (2007) Spinal-injured neuropathic bladder antisepsis (SINBA) trial. Spinal Cord 45:542–550

    Article  CAS  PubMed  Google Scholar 

  33. Günther M, Noll F, Nützel R, Gläser E, Kramer G, Stöhrer M (2002) Harnwegsinfektprophylaxe. Urologe B 42(3):218–220

    Article  Google Scholar 

  34. 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

    Article  CAS  PubMed  Google Scholar 

  35. 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

    CAS  PubMed  Google Scholar 

  36. 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

    Article  CAS  PubMed  Google Scholar 

  37. 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)

    Article  CAS  PubMed  Google Scholar 

  38. 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)

    Article  CAS  PubMed  Google Scholar 

  39. 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

    Article  PubMed  Google Scholar 

  40. 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

    Article  PubMed  Google Scholar 

  41. 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

    PubMed  Google Scholar 

  42. 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

    Article  CAS  PubMed  Google Scholar 

  43. Jonas WB, Kaptchuk TJ, Linde K (2003) A critical overview of homeopathy. Ann Intern Med 4(138):393–399

    Article  Google Scholar 

  44. 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

    Article  PubMed  Google Scholar 

  45. 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

    PubMed  PubMed Central  Google Scholar 

  46. 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

    Article  CAS  PubMed  Google Scholar 

  47. 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

    Article  CAS  PubMed  Google Scholar 

  48. 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

    Article  PubMed  Google Scholar 

  49. Azeredo J, Sutherland IW (2008) The use of phages for the removal of infectious biofilms. Curr Pharm Biotechnol 9:261–266

    Article  CAS  PubMed  Google Scholar 

  50. 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

    Article  CAS  PubMed  Google Scholar 

  51. Gu J, Liu X, Li Y et al (2012) A method for generation phage cocktail with great therapeutic potential. PLoS ONE 7:e31698

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Khawaldeh A, Morales S, Dillon B et al (2011) Bacteriophage therapy for refractory Pseudomonas aeruginosa urinary tract infection. J Med Microbiol 60:1697–1700

    Article  CAS  PubMed  Google Scholar 

  53. 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

    Article  CAS  PubMed  Google Scholar 

  54. 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

    Article  CAS  PubMed  Google Scholar 

  55. 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

    Article  PubMed  PubMed Central  Google Scholar 

  56. 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)

    Article  CAS  PubMed  Google Scholar 

  57. 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

    Article  CAS  PubMed  Google Scholar 

  58. 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

    Google Scholar 

  59. Niël-Weise BS, van den Broek PJ (2005) Urinary catheter policies for long-term bladder drainage. Cochrane Database Syst Rev 25:Cd4201

    Google Scholar 

  60. 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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. 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

    Article  CAS  PubMed  Google Scholar 

  62. 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

    Article  CAS  PubMed  Google Scholar 

  63. 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

    Article  CAS  Google Scholar 

  64. 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

    Article  PubMed  Google Scholar 

  65. 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

    Article  PubMed  Google Scholar 

  66. 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

    Article  CAS  PubMed  Google Scholar 

  67. 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

    Article  PubMed  Google Scholar 

  68. 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

    Article  PubMed  Google Scholar 

  69. 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

    Article  CAS  PubMed  Google Scholar 

  70. 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

    Article  CAS  Google Scholar 

  71. 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

    Article  CAS  PubMed  Google Scholar 

  72. 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

    Article  PubMed  PubMed Central  Google Scholar 

  73. 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

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Neuro-Urologie, Schweizer Paraplegiker Zentrum, Guido A. Zäch Strasse 1, 6207, Nottwil, Schweiz

    Julia Neuenschwander &  Jürgen Pannek

  2. Universitätsklinik für Urologie, Inselspital, Bern, Schweiz

    Jürgen Pannek

Authors
  1. Julia Neuenschwander
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jürgen Pannek
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jürgen Pannek.

Ethics declarations

Interessenkonflikt

J. Neuenschwander und J. Pannek geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

Hinweis des Verlags

Der Verlag bleibt in Hinblick auf geografische Zuordnungen und Gebietsbezeichnungen in veröffentlichten Karten und Institutsadressen neutral.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Neuenschwander, J., Pannek, J. Behandlung rezidivierender Harnwegsinfekte bei PatientInnen mit neurogener Blasenfunktionsstörung. J. Urol. Urogynäkol. AT 29, 32–38 (2022). https://doi.org/10.1007/s41972-022-00158-w

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s41972-022-00158-w

Schlüsselwörter

Keywords

Search

Navigation