Arch Phys Med Rehabil 2002 Jan;83(1):129-138
Morton SC, Shekelle PG, Adams JL,
Bennett C, Dobkin BH, Montgomerie J, Vickrey BG.
OBJECTIVE:
To assess the benefits and harms
of antimicrobial prophylaxis to prevent urinary tract infections (UTIs)
in persons with neurogenic bladders caused by spinal cord dysfunction.
DATA SOURCES:
A broad search strategy with no language
restriction was conducted of MEDLINE (1966-January 1998), EMBASE (1974-January
1998), and CINAHL (1982-July 1998) using the general search terms urinary
tract, urinary tract infections, bacteriuria, paraplegia, quadriplegia,
spinal cord injuries, multiple sclerosis, neurogenic bladder, and neuropathic
bladder. Additional articles were identified by experts and by reviewing
reference lists of articles obtained from searches.
STUDY SELECTION:
Criteria included human studies of
adults and adolescents who had neurogenic bladder due to spinal cord dysfunction;
the studies had to address antimicrobial prophylaxis of UTI and include
bacteriuria or UTI as an outcome. We excluded any study that was clearly
not a controlled trial or that only included children under the age of
13 years. Two reviewers independently abstracted data, and disagreements
were resolved by consensus.
DATA EXTRACTION:
Two reviewers independently abstracted
data, and disagreements were resolved by consensus. Studies were graded
by 1 project investigator according to quality criteria developed by Jadad
and Schulz.
DATA SYNTHESIS:
The sizes of the effect of antimicrobial
prophylaxis on weekly infection rates from 15 trials that met the inclusion
criteria were pooled by using a random effects model. Antimicrobial prophylaxis
did not significantly decrease symptomatic infections. Prophylaxis was
associated with a reduction in asymptomatic bacteriuria among acute patients
(<90d after spinal cord injury; P <.05); 1 patient would require
3.7 weeks of treatment on average to prevent 1 asymptomatic infection.
For nonacute patients, the reduction approached statistical significance
(P =.06). Prophylaxis resulted in an approximately twofold increase in
antimicrobial-resistant bacteria.
CONCLUSIONS:
The regular use of antimicrobial
prophylaxis for most patients who have neurogenic bladder caused by spinal
cord dysfunction is not supported. A clinically important effect, however,
has not been excluded. Future research should focus on randomized trials
in those patients who have recurrent UTIs that limit their daily functioning
and well-being.
Copyright 2002 by the American Congress
of Rehabilitation Medicine and the American Academy of Physical Medicine
and Rehabilitation