Efficacy of Antibiotic Coated Clean Intermittent Catheterization in Children with Neurogenic Bladder
Aim: The primary goal of urologic management in children with neurogenic bladder is to reduce the risk of urinary tract infection (UTI) and associated renal injury. We aimed to evaluate the use of antibacterial-coated clean intermittent catheterization (CIC) catheters for neurogenic bladder patients in comparison with standard catheters. Material and Methods: We performed a retrospective study of 144 neurogenic bladder patients aged 6-16 years old, who received CIC at two major centers between January 2007 and June 2016. Group 1 consisted of children used antibacterial coated (chitosan) catheter (n=55), group 2 of children used standard CIC without antibacterial (n=42) and group 3 of children used standard CIC returned into antibiotic coated CIC (n=29). Febrile urinary tract infection and asymptomatic bacteriuria were evaluated among patients with antibacterial coated or standard catheters. We also focused on a subgroup of patients with high risk of urinary tract infection (grade 3> vesicoureteral reflux, previously scar formation in renal scintigraphy). Results: Totally 126 patients (89 female, 37 male) were involved in this study. The mean age of the study group was 9.6±2.6 years (range 6 to 16) and the mean follow-up 58±14 months (min: 22, max: 69). There was no significant difference between three groups for asymptomatic bacteriuria and febrile UTI frequencies. However, febrile UTI frequencies and de nova scar formation in renal scintigraphy were higher in previously defined subgroup of patients with high risk of urinary tract infection in group 2 than group1 and 3. Discussion: Both antibiotic coated and standard CIC can be used in children with neurogenic bladder with similar complication rates. Patients with high risk of urinary tract infection (higher than grade 3 vesicoureteral reflux, dilated ureter, previously de nova scar formation in renal scintigraphy) will benefit from antibacterialcoated catheters rather than standard ones.
. Tekgul S, Dogan HS, Hoebeke P, et al (2016) Guidelines on Paediatric Urology. European Association of Urology Avaible at: http://uroweb.org/wp-content/uploads/23-Paediatric-Urology_LR_full.pdf Giriş Tarihi: 12.06.2016
. Jones KV, Asscher AW. Urinary tract infection and vesicourethral reflux. In: Edelman CM (editor). Pediatric Kidney Disease, 2nd ed, Boston, Little Brown; 1992.p.1943-1991.
. Schlager TA, Dilks S, Trudell J. et al. Bacteriuria in children with neurogenic bladder treated with intermittent catheterization: natural history. J Pediatr. 1995;126:490-496.
. Kanaheswari Y, Kavitha R, Rizal AM. Urinary tract infection and bacteriuria in children performing clean intermittent catheterization with reused catheters. Spinal Cord. 2014 Nov 25.
. Wyndaele JJ, De Ridder D, Everaert K, et al. Evaluation of the use of Urocath-Gel Ankara Üniversitesi Tıp Fakültesi Mecmuası 2016, 69 (3) 236 Çocuklarda Nörojenik Mesanede Antibakteriyel Kateterle Temiz Aralıklı Kateterizasyon Etkinliği; Retrospektif Çalışma catheters for intermittent self-catheterization by male patients using conventional catheters for a long time Spinal Cord. 2000; 38: 97-99.
. Bakke A: Clean intermittent catheterization. Physical and psychological complications. Scand J Urol. 1993; 150: 69.
. Hellstrom P, Tammela T, Lukkarinen O, et al: Effica- cy and safety of clean intermittent catheterization in adults. Eur Urol. 1991; 20: 117-121.
. De Ridder DJ, Everaert K, Fernández LG, et al. Intermittent catheterisation with hydrophilic-coated catheters (SpeediCath) reduces the risk of clinical urinary tract infection in spinal cord injured patients: a prospective randomised parallel comparative trial. Eur Urol. 2005; 48: 991-995.
. Heard L, Buhrer R. How do we prevent UTI in people who perform intermittent catheterization? Rehabil Nurs. 2005; 30: 44-45, 61.
. Schmidt B, Copp HL. Work-up of Pediatric Urinary Tract Infection. Urol Clin North Am. 2015; 42: 519-526. 14. Saint S, Chenoweth CE. Biofilms and catheter-associated urinary tract infections. Infect Dis Clin North Am. 2003;17: 411- 432.
. Herz D, Merguerian P, McQuiston L. Continuous antibiotic prophylaxis reduces the risk of febrile UTI in children with asymptomatic antenatal hydronephrosis with either ureteral dilation, high-grade vesicoureteral reflux, or ureterovesical junction obstruction. J Pediatr Urol. 2014; 10: 650-654.
. Kaye IY, Payan M, Vemulakonda VM. Association between clean intermittent catheterization and urinary tract infection in infants and toddlers with spina bifida. J Pediatr Urol. 2016 Mar 4.
. Yang SH, Lee YS, Lin FH, et al. Chitosan/poly (vinyl alcohol) blending hydrogel coating improves the surface characteristics of segmented polyurethane urethral catheters. J Biomed Mater Res B Appl Biomater. 2007; 83: 304-313.
- There are currently no refbacks.