|Lee et al. 2007|
|Population: SCI with Neurogenic bladder and stable management: Mean age: 43.5 yr; Gender: males=253, females=52; Level of injury: paraplegia=137, tetraplegia=168; Severity of injury: complete=149, incomplete=156|
Intervention: Double-blinded comparison of methenamine hippurate (MH, 2g) with cranberry (1600mg), MH (2g) with cranberry placebo, cranberry (1600mg) with MH placebo or MH placebo with cranberry placebo).
Outcome Measures: Time to symptomatic urinary tract infection (UTI) (culture), predictors of UTI, adverse events collected for up to 6 mo.
|1. The Kaplan-Meier curves for MH and Cranberry compared to placebo showed no evidence of a treatment effect.|
2. The unadjusted analysis confirms that there was no statistically significant effect of MH tablets (HR 0.94, 95% confidence interval 0.68-1.32) or cranberry tables (HR 0.93, 95% CI 0.66-1.29).
3. The only significant predictor of a future UTI was found to be the number of UTIs in the preceding 6 mo.
4. Common adverse effects included diarrhea or constipation.
5. There was no difference in adverse event rates between the groups.
|Waites et al. 2006|
|Population: SCI or other neurological disease with indwelling or suprapubic catheter with bacteriuria and pyuria: Mean age: 45.8 yr; Gender: males=49, females=40; Mean time post-injury=11.2 yr.|
Intervention: Comparison of twice daily bladder irrigation with normal saline versus 0.25% acetic acid versus neomycin-polymyxin (N-P) GU irrigant for treatment of bacteriuria for 8 weeks.
Outcome Measures: Numbers and types of bacteria (culture and susceptibility), urinary pH, urinary leukocytes, generation of antimicrobial-resistant organisms collected at baseline, 2, 4, and 8 wk.
|1. No difference among 3 irrigation solutions for bacteriuria.|
2. Overall, no difference in bacteriuria for any 7 of 8 species (p>0.1) other than Enterococcus spp. which increased significantly from week 0 to 8 (p=0.0006) and between solutions was significant for N-P group only (p=0.02).
3. Mean urinary pH for all 3 groups increased from mean of 6.6 to 7.0—7.2 range (p=0.01) at wk 8.
4. No significant increase in urinary leukocytes in any group (p≥0.6), MRSA (p≥0.37) or gram-negative resistance to common UTI antimicrobials (p≥0.11).
|Castello et al. 1996 Spain|
|Population: SCI: Mean age: 27.83 yr; Gender: males=9, females=4; Level of injury: paraplegia=12, tetraplegia=1.|
Intervention: Ascorbic acid versus placebo (lactose) for urinary tract infection (UTI) prophylaxis for an unspecified duration.
Outcome Measures: Urine pH, culture.
|1. No significant difference in baseline or post- treatment urine pH for ascorbic acid or placebo, or number of individuals developing UTI between groups.|
|Sanderson & Weissler|
|Population: SCI rehabilitation inindividuals: Gender: males=16, females=3.|
Intervention: Individuals washed daily in chlorhexide versus unmedicated soap for 8 wk with crossover. Individuals receiving antibiotics for either urinary tract infections (UTIs) or skin infections were analysed separately as 3rd and 4th groups depending on their initial treatment (chlorhexide versus soap).
Outcome Measures: Bacteriuria assessed by urine culture, perineal colonization (swab), bedsheet, pillow case and environmental swab samples collected each week day.
|1. Bacteriuria reduced by washing with chlorhexidine versus soap. (p<0.01).|
2. Bacteriuria less for those on antibiotics and using chlorhexidine (0.05<p<0.01).
3. Proportion of negative cultures progressively rose for those on soap alone, to those on chlorhexidene alone, to those on antibiotics with soap, to those on antibiotics with chlorhexidene.
4. Antibiotics usage resulted in significant increase in perineal swabs negative for coliforms (p<0.01).
|Pearman et al. 1988 Australia|
|Population: SCI inindividual: Age range 18-49 yr; Gender: males=15, females=3.|
Intervention: Trisdine bladder instillation following intermittent catheterisation versus kanamycin and colistin bladder instillation.
Outcome Measures: Episodes of bacteriuria, number of catheterizations.
|1. No significant difference (chi square, no p value given) in number of episodes of bacteriuria between Trisdine versus kanamycin-colistin bladder instillations;|
2. 0.56% (9 of 1609) versus 0.53% (9 of 1704) of instillations were associated with episodes of bacteriuria for Trisdine versus kanamycin-colistin respectively.
|Krebs et al. 1984|
|Population: Inindividual SCI (≤6 mo post-injury) with intermittent catheterization; Gender: males=40, females=0; Level of injury: T6 & above=27, T7 & below=13.|
Intervention: Instillation of 45 ml, 5% hemiacidrin solution at each catheterization and 2 mg methanamine mandelate orally 4 times daily versus no bacterial prophylaxis.
Outcome Measures: Urinary pH determination culture, rate of urinary tract infections (UTIs), antibiotic susceptibility collected weekly during length of hospital stay.
|1. Urine pH lower in methenamine and hemiacidrin group (p<0.01).|
2. Control group had double the number of positive cultures (p<0.001).
3. UTI rates were higher in controls (p<0.02).
4. Higher rate of symptomatic UTI in controls (chi-square 3.84, p<0.05).
|Wikstrom et al. 2018|
|Population: Mean age=43.7yr, Gender: males=19, females=2; Etiology: SCI (n=21, 100%); Inclusion criteria: SCI; IC as primary as chief method of bladder management; history of recurrent symptomatic UTI; with asymptomatic bacteriuria|
Intervention: Bladder irrigation with 120 mL of 0.2% chlorohexidine solution was performed 2x/d (morning and evening) for up to 7d. The instilled solution was drained using IC after 15min of being in the bladder.
Outcome Measures: Bacteriuria levels below cut-off value; return of bacteriuria to above cut-off levels; adverse events.
|1. There was a significant reduction in bacteriuria above the set cut-off after post-treatment (p<0.005).|
2. Eight of 14 subjects had a subsequent return of bacteriuria levels above the set cut-off one day post-treatment.
3. Seven adverse events were reported by six subjects: urine leakage; cramping sensation in bladder; increased urine leakage; diarrhea, symptomatic UTI post-treatment.
|Shigemura et al 2015|
|Population: SCI, NBD; Type of injury: SCI=38, encephalomyelitis=1, spinal tumor=1, aneurysm=1.|
Intervention: Researchers recommended preventative measures to limit the spread and development of multidrug-resistant Pseudomonas aeruginosa (MDRP) outbreaks. Outbreak trends were monitored over an 8 mo period.
Outcome Measures: Spread of MDRPs within individual population, catheterization use.
|1. Eighteen MDRPs were detected in 8 mo of surveillance. The isolation of MDRPs significantly decreased from the 1st quarter to the last (p=0.02), even though urinary tract device use significantly increased (p<0.001).|
2. Rates of hand washing, thoroughness and checking of standard precautions, the use of common shelves for personal antiseptic solutions were the measures recommended seen to improve the rates of MDRPs in individuals.
|Jia et al. 2013|
|Population: Mean age: 36 yr; Gender: males=41, females=0; Severity of injury: C2-6 =9, T1-6=8, T7-12=19, L1=5.|
Intervention: Individuals were administered a 300 U injection of botulinum toxin A.
Outcome Measures: Number of UTIs.
|1. The mean number of UTIs significantly decreased post-injection (p=0.023).|
2. The decrease of UTI was significant in the detrusor over-activity individuals (p=0.015), while the decrease was not significant in norm-active detrusor individuals (p=0.319).
|Game et al. 2008|
|Population: Mean age: 39.4 yr; Gender: males=18, females=12; Etiology of neurogenic detrusor over activity: Multiple sclerosis=15, SCI=14, Myelitis=1.|
Intervention: Individuals were administered an injection of 300 U OnaBTx into the detrusor muscle.
Outcome Measures: Frequency of urinary tract infections (UTI).
|1. The mean number of UTIs was significantly different from pre-injection compared to post-injection (p=0.003); just 3 individuals still acquired UTIs post injection.|
|Schlager et al. 2005|
|Population: Neurogenic bladder caused by myelomeningocele=5, and traumatic SCI=2, and using clean intermittent catheterization: Age range 18-29 yr; Gender: males=3, females=4; Level of Injury: L2 & 4, T6, 8 & 12(x2); Time post-injury>2 yr.|
Intervention: Phosphorus supplement (Neutra-phos®) as urine-acidifying agent. Wk 2 and 3, individual drank a phosphorus supplement 3 times/d over 4 wk study period.
Outcome Measures: Urinalysis (Urine pH) measured 3 times/d (1st morning, afternoon, evening) for 4 wk; urine sample (cultured) 2 times/wk over 4 wk.
|1. No significant change in urine pH during the 2-wk period when individual was on phosphorus supplement (vs when off supplement).|
2. Urine acidification not achieved with phosphate supplement.
3. Frequency of bacteriuria in an individual individual was similar on and off supplementation.