Columbus, OH - May 2016
Clinicians have a particularly difficult time diagnosing urinary tract infections (UTIs) in some groups; patients with myelomeningocele, for example, regularly have bacterial colonization as a result of clean intermittent catheterization. But that does not necessarily indicate UTI.
Some urologists choose to treat bacteriuria in patients with neurogenic bladders, even if asymptomatic, in an effort to be cautious. A catheter that limits bacterial colonization, however, could also limit the need for treatment with antibiotics. A recent study led by researchers at Nationwide Children’s Hospital has shown a trend toward reduced potential pathogenic bacteria collection in patients who use hydrophilic catheters.
“It’s a tough clinical situation, and since we don’t want to be wrong, often clinicians end up giving these patients a course of antibiotics,” says Elizabeth Lucas, MD, a member of the Section of Complex Care at Nationwide Children’s and lead author of the study. “That leads to increased resistance, not to mention the possible side effects and extra costs. Hydrophilic catheters could have a positive impact.”
The prospective, randomized and investigator-blinded study was published in the Journal of Pediatric Urology and involved 50 patients with myelomeningocele. All had a history of clean intermittent catheterization with conventional polyvinyl chloride catheters. Half were assigned to use hydrophilic catheters during clean intermittent catheterization for one year. The other half continued using PVC catheters.
Urine samples were taken by clean intermittent catheterization and cultured at enrollment, and at 3, 6 and 12 months. While not statistically significant, there was an overall 40 percent decrease in average number of potentially pathogenic bacteria species recovered from the hydrophilic patients versus PVC patients. Researchers also saw a continual reduction in the recovery of potentially pathogenic species over the one-year study period.
The most common bacteria recovered from samples were E. coli, both pathogenic and non-pathogenic strains. At the beginning of the study period, both cohorts had a similar number of samples with uropathogenic E. coli serotype positive isolates recovered. During the rest of the study, fewer UPEC serotypes were recovered from the hydrophilic group than the PVC group, though the result was not significant.
“I think patients will continue to use PVC catheters,” says Dr. Lucas, who is also an assistant professor of Pediatrics at The Ohio State University College of Medicine. “The results are not compelling enough to get us to all change our practice. It does, though, lead me to consider using hydrophilic catheters for patients who have a history of UTI.”
The study examined patient satisfaction with the catheters as well. While patients had equal satisfaction with either catheter, nine patients continued use of the hydrophilic catheter after completion of the study.
“Some patients found the hydrophilic catheter more convenient, in part because it is pre-lubricated,” says Cheryl Baxter, CPNP-PC, a coauthor of the paper and member of the Section of Urology at Nationwide Children’s. “As they developed some skill with it, some also found that it was able to be inserted more easily.”
Lucas EJ, Baxter C, Singh C, Mohamed AZ, Li B, Zhang J, Jayanthi VR, Koff SA, VanderBrink B, Justice SS. Comparison of the microbiological milieu of patients randomized to either hydrophilic or conventional PVC catheters for clean intermittent catheterization. Journal of Pediatric Urology. 2016 Feb 18. [Epub ahead of print]