|Morton et al. 2002|
|Population: Acute studies=8 (individuals with SCI<90 days ago; n=510): Treatments: trimethoprim, sulfamethoxazole, neomycin, polymiyxin B, nitrofurantoin, methenamine hippurate, methenamine madelate, hemiacidrin, ascorbic acid.|
Nonacute studies=7 (individuals with SCI>90 days ago (n=356): Treatments: nitrofurantoin, methenamine, mandelate, ammonium chloride, sulfamethoxazole, trimethoprim, ciprofloxacin, ascorbic acid.
Intervention: Literature search of Medline (1966- January 1998), Embase (1974-January 1998), and cinahl (1982-July 1998).
Outcome Measures: Symptomatic Urinary tract infections (SUTI), asymptomatic bacteriuria count.
|1. Antimicrobial prophylaxis did not significantly decrease SUTIs in either acute or nonacute individuals (p>0.05).|
2. Antimicrobial prophylaxis reduced asymptomatic bacteriuria in acute individuals (p<0.05), and nonacute individuals (p=0.06) but the reduction was not significant in either.
|Darouiche et al. 1994|
|Population: SCI Inindividuals: Treatment group: Mean age: 52.9 yr; Gender: males=18, females=0; Placebo group: Mean age: 46.9 yr; Gender: males=22, females=0.|
Intervention: Double blind comparison of 500mg of ciprofloxacin bid versus placebo bid for 3 d prior to urodynamic testing.
Outcome Measures: Incidence of urinary tract infection (UTI) (culture), bacteriuria, pyuria, adverse events collected prior and 3-5 d post urodynamic testing.
|1. 3 individuals in the placebo group and none the individuals in the treatment group developed symptomatic UTI but this was not significant (p=0.24).|
2. No adverse effects were reported.
|Biering-Sorensen et al. 1994|
|Population: SCI with neurogenic bladder: Mean age: 38 yr; Gender: males=18, females=3.|
Intervention: Cross-over comparison of 6 mo ciprofloxacin (100mg/night) versus placebo prophylaxis.
Outcome Measures: Number of urinary tract infections (UTIs), urine and fecal cultures, side effects collected over 6 mo periods.
|1. Ciprofloxacin versus placebo prophylaxis (6 mo): number of UTIs greatly reduced with 5 versus 59 (p<0.00005)|
2. 1 instance of ciprofloxacin resistant E. coli found in the feces of 1 cipro individual
3. No severe side effects.
|Gribble & Puterman 1993|
|Population: Acute (<30 d) SCI: Mean age: 38 yr; Gender: males=112, females=17.|
Intervention: Efficacy of trimethoprim-sulfamethoxazole (TMP-SMX; TMP 40 mg, SMX 200mg) for UTI prophylaxis in acute SCI, during the first 4 mo of intermittent catheterization (IC). Breakthrough bacteriuria treated with conventional antimicrobial therapy and prophylaxis was continued.
Outcome Measures: Clinical: weekly rectal and urethral swab and urine cultures collected for 4 mo or until hospital discharge.
|1. TMP-SMX more efficacious than placebo (P) prophylaxis:|
· Lower incidence/freq/relapse of bacteriuria and symptomatic UTI in males (p<0.003 /0.0001/0.0001 and 0.0003).
· Similar trends in women.
2. Other results:
· Adverse events similar between groups
· ≥1 TMP-SMX-resistant bacteriuria in all P subjects by yr 3.
· Rectal/urethral swab TMP-SMX-resistant organisms-both grps.
· TMP-SMX UTI prophylaxis effective in acute SCI/IC but emergent TMP-SMX-resistance limits usefulness.
|Sandock et al. 1995|
Prospective Controlled Trial
|Population: SCI inindividuals; Treatment group: Mean age: 46 yr; Gender: males=20; Level of injury: lumbar=2, paraplegic=5, tetraplegia=13; Mean time post-injury=9.2 yr; Control group: Mean age: 58.3 yr; Gender: males=23; Level of injury: lumbar=3, paraplegic=8, tetraplegic=12; Mean time post-injury=14.9 yr.|
Intervention: Comparison of 400mg trimethoprim-sulfamethoxazole (TMP-SMX) daily versus no treatment over a minimum of 3 mo.
Outcome Measures: Incidence of asymptomatic bacteria, prevalence of urinary tract infection UTI, types of bacteria present. Urine cultures weekly.
|1. No significant difference was found between the control and treatment groups in:|
· Incidence of asymptomatic bateriuria.
· Percent of cultures with asymptomatic bacteriuria (p>0.1).
· Incidence of symtomatic UTIs per week (p>0.5).
· Percentage of TMP-SMX resistant UTIs (p>0.5).
· Types of bacteria present.
2. The control group was signficantly lower than the treatment group in:
· Percent of cultures with TMP-SMX resistant asymptomatic bateriuria (p<0.05).
Reid et al. 1994a
Prospective Controlled Trial
|Population: SCI inindividuals with intermittent catheterization: Age range 20-66 yr; Gender: males=11, females=3.|
Intervention: Comparison of co-trimoxazole (TMP-SMX 160/800 mg bid) versus no prophylaxis. Symptomatic urinary tract infections (UTIs) were treated with appropriate antibiotic and a separate analysis was done on effect of fluoroquinolones (ciprofloxacin, ofloxacin and norfloxacin) on bladder biofilm bacteria.
Outcome Measures: Infection rate, extent of biofilm formation, level of bacterial adhesion; urine samples collected for culture and sonication for 8 wk.
|1. TMP-SMX versus non-prophylaxis prophylaxis subjects:|
· 54% versus 68% infection rate (not significant; no p value reported)
· E coli replaced by E faecalis as dominant uropathogen with TMPSMX use.
· 39±42 versus 44±49adherent bacteria/bladder cell (not significant; no p value reported)
2. Laboratory results for treatment effect of fluoroquinolones versus TMP-SMX prophylaxis on biofilms:
· Reduced adhesion counts in favour of Fluoroquinolone versus TMP-SMX (63% versus 44%, no p value).
· 92%, 71%, 56% biofilm reduction with ciprofloxacin, ofloxacin & norfloxacin.
|Chew et al. 2018|
|Population: Long-term nitrofurantoin (LTN): Mean age=60.5±12.4yr; Gender: males=208, females=17; Etiology: SCI=225; Time since injury=24.4±14.2yr|
Control (CG): Mean age=61.1±12.2yr; Gender: males=187, females=9; Etiology: SCI=196; Time since injury=22.0±13.9yr. Inclusion criteria: recurrent (≥3) positive urine cultures and at least one occurrence of UTI or asymptomatic bacteriuria.
Intervention: Medical records of SCI individuals who received long-term nitrofurantoin (≥90 d) for treatment of UTI and SCI individuals who did not receive nitrofurantoin (controls) were reviewed. Clinical outcomes of asymptomatic bacteriuria and UTI occurring during the study year (2012-2013) were extracted.
Outcome Measures: UTI frequency; number of days between positive urine cultures; frequency of isolates in urine; presence of nitrofurantoin-resistant isolates; presence of multidrug-resistant organism isolates; number of outindividual encounters; hospitalization.
|1. There were no significant differences in the frequency or types of UTI symptoms when comparing LTN to CG (p>0.05).|
2. CG had a higher proportion of positive urine cultures compared to LTN (p<0.001).
3. CG had significantly fewer nitrofurantoin-resistant isolates (p<0.001). However, there was no significant difference in the number of multidrug-resistant organism isolates between CG and LTN (p>0.05).
4. Average number of days between positive urine cultures was significantly shorter in the CG group compared to LTN (p<0.001).
5. There was no significant difference in the frequency of isolates between CG and LTN (p>0.05).
6. LTN had significantly fewer outindividual encounters, and hospitalizations compared to CG (p<0.001).
|Cox et al. 2017|
|Population: Median age=37.5yr (18-75); Gender: males=13; females=9; Etiology: SCI (n=14, 63.6%); Multiple Sclerosis=3; Myelodysplasia=2; Transverse Myelitis=2; Other=1, Median time since injury=14yr.|
Intervention: 480 mg of gentamicin was diluted in 1 L of water. Each individual received a gravity instilled dose of 30-60 mL (dependent on bladder capacity) of solution instilled into the bladder after drainage of urine was complete at the individual’s last evening catheterization. Instillations were left indwelling until the next catheterization.
Outcome Measures: Symptomatic UTI median; Courses of oral antibiotics; Courses of IM or IV antibiotics; Days of antibiotic therapy; ED/hospital visits for UTI; Telephone encounters for UTI; Multidrug-resistant organisms; Gentamicin resistant organisms
|1. The incidence of symptomatic UTI decreased significantly (p<0.004).|
2. Individuals underwent fewer course of treatment with oral antibiotics after gentamicin instillations (p<0.01).
3. There was a significant decrease in the number of individuals who used oral antibiotic prophylaxis (p=0.03).
4. There was a significant decrease in the proportion of multidrug-resistant organisms in urine culture (p=0.04).
5. The number of telephone encounters for UTI decreased significantly (p=0.03).
|Poirier et al 2016|
|Population: SCI, NBD; Mean age: 51 yr; Gender: males=30, females=20; Level of injury: paraplegia=33, tetraplegia=6, MS=4, other=6, missing data=1; Mean time post-injury: 19.4 yr.|
Intervention: Alternate weekly administration of oral antibiotics, which have been proven effective in treating UTIs.
Outcome Measures: UTI frequency (per year), antibiotic use post regimen, presence of multidrug resistant bacteria (MDRB) in rectal swabs.
|1. The number of UTIs per year significantly decreased with oral antibiotic cycling (p<0.001).|
2. The number of antibiotic treatments per year (p<0.001) and the number of hospitalizations per year (p=0.001) also significantly decreased with cycling treatment. Additional antibiotic treatment length was also significantly shorter (p<0.001) if individuals were already on antibiotic cycling treatment.
3. MDRB presence significantly decreased in individuals after starting antibiotic cycling (p<0.001).
|Chong et al. 2015|
|Population: Mean age: 55.75 yr; Gender: males=59, females=1; ASIA classification: A=34, B=11, C=9, D=6; Short-term treatment=35, Long-term treatment=25.|
Intervention: Individuals either received 1-day of pre-procedural antibiotic treatment or 3-5 days of pre-procedural antibiotic treatment before a urological procedure.
Outcome Measures: Quality of life (EQ-5D), physical exam data (vital signs), antibiotic usage (type, frequency), post-procedural day 1 white blood cell count (WBC), complications (UTIs).
|1. There were no significant differences in EQ-5D scores between the short-term and long-term treatment groups. The long-course group reported significantly higher anxiety levels pre-procedurally when reporting anxiety/depression (p=0.010) and “extremely anxious” (p=0.010) compared to the short treatment group.|
2. There were no significant differences in vital signs between or within groups, pre or post procedure. Additionally, the WBC was similar in both groups.
3. Five adverse events occurred, 2 participants from the long-course group and 3 from the short-term group. One participant from each group was found to have urosepsis and was admitted to the intensive care unit for treatment.
|Salomon et al. 2009|
|Population: Mean age: 34 yr; Gender: males=0, females (pregnant)=6; paraplegic=4, tetraplegic=2.|
Intervention: Weekly oral cyclic antibiotic (WOCA) program.
Outcome: Urinary tract infection (UTI) rate, birth weight, obstetric and neonatal characteristics.
|1. Significant reduction in UTI rate. Only 2 individuals had a UTI compared to before the treatment with 6 UTI per yr per individual (p<0.001).|
2. No complications were observed during the delivery.
3. All newborns were born healthy with a mean weight of 3180g.
|Salomon et al. 2006 France|
|Population: SCI with neurogenic bladder and undergoing intermittent catheterization; Mean age: 45.9 yr; Gender: males=22, females=16; daily catheterizations=6.|
Intervention: Weekly oral cyclic antibiotic (WOCA): Wk 1-one antibiotic+wk 2 another antibiotic (over 2 yr). Antibiotic choice based on urine culture results: amoxicillin 3000mg; trimethoprim/ sulfamethoxazole 320-1600mg; fosfomycin trometamol 6000mg; nitrofurantoin 300mg; cefixime 40mg.
Outcome Measures: Number of urinary tract infections (UTIs) with weekly cultures for first 3 mo and monthly thereafter over 2 yr.
|Before/after WOCA programme:|
· Reduced symptomatic UTIs/ pt/yr from 9.4 to 1.8, p<0.01
· Reduced febrile UTI/pt/yr from 0.75 to 0.31, p<0.04
· Reduced hospitalization days from 4 to 1.2 d/individual, p<0.01.
· Decreased antibiotic consumption correlated with decreased incidence of UTIs over the course of the study.
|Previnaire et al. 2017|
|Population: Mean age=40.9±16.8; Gender: males=43; females=14; Etiology: SCI=57; Mean time since Injury: 18.4±49.1 mo; Inclusion criteria: individuals using IC; presence of UTI compatible with cystitis; prescription of a 5-day narrow spectrum antibiotic for either symptomatic or asymptomatic bacteremia.|
Intervention: Individuals were divided into 4 groups: Group 1 (recurrence of a treated UTI); Group 2 (occurrence of UTI after treatment for asymptomatic bacteriuria); Group 3 (treatment for asymptomatic bacteriuria after UTI); Group 4 (consecutive treatments for asymptomatic bacteriuria). Common 5-day narrow spectrum antibiotic treatments included: Third-generation cephalosporin; Trimethoprim-sulfamethoxazole; Fluoroquinolone; Nitrofurantoin. Outcome measures were assessed at 3, 6, 9wk follow-ups.
Outcome Measures: occurrence of UTI; Duration of UTI-free urine; clinical cure at end of therapy for UTI; relapse and reinfection rates.
|1. There was a 99% eradication rate and 100% clinical cure rate for subjects treated for UTI.|
2. There was no significant difference in the UTI-free period after treatment for asymptomatic bacteriuria compared with treatment for UTI (p>0.05).
3. There was no significant difference in UTI rates after treatment of UTI or asymptomatic bacteriuria (p>0.05).
4. There was no significant difference in UTI rates between those who underwent non-urological procedures and those who underwent invasive urological exams (p>0.05).
5. There was no significant difference in UTI-free periods between Group 1 and Group 2 (p>0.05).