Short summary

Recurrent urinary tract infections (UTI) in the patients chronically catheterized are actually biofilm infections, which are serious challenges clinically. The standard antibiotic treatment against recurrent UTI in Denmark is antibiotic monotherapy, which functions poorly against biofilm infections. In the study, the participants will be divided into monotherapy, combination, and bladder lavage three groups. We will find a best/better treatment from the groups, which benefits the patients.

Rationale

Multidrug resistant bacterial infections are serious challenges that human beings are facing. Recurrent urinary tract infections (UTI) in the patients chronically catheterized is one of the examples. Urinary catheterization not only impair the urinary tract self-clean mechanism, but also provide the urinary pathogens an ideal surface to form bacterial biofilms, which have been demonstrated in vivo and in vitro impossible to be removed by only antibiotic treatments. Repeated antibiotic treatments could not help to remove urinary biofilm infections, but inducing antibiotic resistance. Currently treatment against recurrent UTI in urinary catheterized patients includes antibiotic treatment and replacement of urinary catheter. Antibiotic treatment aims to remove the planktonic bacteria, control clinical symptoms and localize the infection in urinary tract, which will help to limit the bacteria in the catheter biofilm and benefit the replacement of the infected catheter.

At present, standard antibiotic treatment against UTI in catheter carriers is sensitive antibiotic monotherapy according to the Danish guidelines on the use of antibiotics in the website "pro.medicin.dk". However, these kinds of UTIs are usually biofilm infections, especially the urinary pathogen are quite often multiple-resistant. Therefore, some of the hospitals prefer combination antibiotic treatments according to the results from biofilm in vivo and in vitro researches. There are currently always arguments regarding monotherapy and combination antibiotic treatments. Our project intends to observe and compare both treatments and try to clarify their respective advantages and disadvantages, which will benefit our clinical treatments and control of the antibiotic resistance in future. In addition, some of the patients have poor renal function, which reduce significantly the antibiotic concentration in urine. In such situation, bladder-antibiotic lavage might help. In the study, the patients will be randomly divided into three groups (monotherapy, combination and bladder lavage). We will evaluate the results and find a better treatment based on the clinical evidences, which might benefit our patients.

Description of the cohort

The project is running in collaboration with Department of Urinary Surgery at Hospital South West Jutland, University Hospital of Southern Denmark. The participants will be selected from their Outpatient Clinic and admitted to hospital for one week or so.

Inclusion Criteria:

• Patients, who have long-term urinary catheter in situ with recurrent UTI and are admitted or referred to an ambulatory due to acute episode of UVI (acute local symptoms include pyuria or urine stick positive, suprapubic pain or tenderness, costovertebral angle pain or tenderness, catheter obstruction, or acute hematuria) or urosepsis (If a bacteriuric patient has positive blood culture with fever, leukocytosis and high C-reaction protein, and the cultured bacteria in urine and blood are consistent, urosepsis is diagnosed) will be included to the project.

Exclusion Criteria:

• Patients with nephrostomy catheters, J-J catheter, bricker bladder or urinary stones will be excluded from the project.

Data and biological material

Urine or and blood samples will be collected from the patents to microbiological examinations including bacterial culture, identification and antibiotic sensitivity test. Some clinical factors, such as age, sex, clinical symptoms, temperature, blood pressure, leukocyte count and differential count, C- reaction protein level and renal functions etc. will be collected from medical records and post-discharge clinical symptom record form of the patients.

Collaborating researchers and departments

Department of Urinary Surgery, Esbjerg Hospital (SVS)

• Majken Højrup Wiborg, afdelingslæge
• Søren Sørensen Madsen, ledende overlæge

Department of Clinical Microbiology, Esbjerg Hospital (SVS)

• Zhijun Song, overlæge, klinisk lektor
• Esad Dzajic, overlæge
• Raluca Datcu, afdelingslæge
• Marc Trunjer Kusk Nielsen, specialansvarlig overlæge