Vol.69 No.2 March 2021
Asymptomatic bacteriuria and urinary tract infection in patients with practicing clean intermittent self-catheterization
1)Department of Urology, Sapporo Medical University School of Medicine, South 1, West 16 Chuo-ku, Sapporo, Hokkaido, Japan
2)Teine Urologic Clinic
3)Department of Infection Control and Laboratory Medicine, Sapporo Medical University School of Medicine
4)Department of Urology, Japanese Red Cross Asahikawa Hospital
5)Department of Urology, Takikawa Municipal Hospital
Abstract
The usefulness of prior urinary cultures in patients with intermittent self-introduction practicing clean intermittent catheterization (CIC) has not yet been evaluated sufficiently. Therefore, we examined the significance of prior culture in patients practicing CIC.
Patients who undertook CIC between March 1, 2013 and October 31, 2014 were enrolled in the study. Data on the patient background characteristics were collected from their medical charts and through interviews. Screening urine cultures were performed at entry and every six months thereafter. Symptomatic urinary tract infections (sUTI) during the observation period were defined by the occurrence of fever (more than 38°C) or lower urinary tract symptoms and urine culture showing more than 103 CFU/mL bacteria.
A total of 73 patients were enrolled. The median observation period was 13.5 months. Asymptomatic bacteriuria was observed in 62 cases (85%), including in some cases during the course of observation. Many gram-negative bacteria were isolated, and in most cases, the isolated organism was Escherichia coli. The complete concordance rates between the results of cultures performed at entry and at 6 months after entry was 33.9%. The complete concordance rate between the results of cultures at 6 months and at 12 months after entry was 40.3%. The prevalence of E. coli and E. coli was 57.5%. There were no differences in the susceptibility to fluoroquinolones between these E. coli strains.
There were 22 events of urinary tract infection in 33 patients during the observation period, corresponding to 0.45 event/person-year. The causative organism was identified in 21 events, and the latest screening culture was positive in 11 events. In 6 events, the causative pathogens isolated were identical to those isolated at the latest screening. In 5 of the 6 events, E. coli strains were isolated.
If screening in patients practicing CIC reveals E. coli. The same E. coli strains tend to be detected continuously and to maintain its drug resistance pattern. Our findings indicate that prior urinary cultures might contribute to infection control and appropriate selection of antimicrobial agents in patients with sUTI.
Key word
clean intermittent catheterization, asymptomatic bacteriuria, surveillance culture, urinary tract infection, drug resistant bacterium
Received
July 6, 2020
Accepted
November 20, 2020
Jpn. J. Chemother. 69 (2): 117-122, 2021
