A Bacterial Interference Strategy for Prevention of UTI in Persons Practicing Intermittent Catheterization

STUDY DESIGN: Non-randomized pilot trial OBJECTIVES: Determine whether Escherichia coli 83972-coated urinary catheters in persons with spinal cord injury (SCI) practicing an intermittent catheterization program (ICP) could (1) achieve bladder colonization with this benign organism, and (2) decrease the rate of symptomatic urinary tract infection (UTI). SETTING: Outpatient SCI clinic in a Veterans Affairs hospital (USA) METHODS: Participants had neurogenic bladders secondary to SCI, were practicing ICP, had experienced at least 1 UTI, and had documented bacteruria within the past year. All subjects received a urinary catheter that had been pre-inoculated with E. coli 83972. The catheter was left in place for 3 days then removed. Subjects were followed with urine cultures and telephone calls weekly for 28 days and then monthly until E. coli 83972 was lost from the urine. Outcome measures were (1) the rate of successful bladder colonization, defined as the detection (≥10(2) cfu/ml) of E. coli 83972 in urine cultures for > 3 days after catheter removal and (2) the rate of symptomatic UTI while colonized with E. coli 83972. RESULTS: Thirteen subjects underwent 19 insertions of study catheters. Eight subjects (62%) became successfully colonized for > 3 days after catheter removal. In these 8 subjects, the rate of UTI while colonized was 0.77 per patient-year, in comparison to the rate of 2.27 UTI per patient-year prior to enrollment. CONCLUSIONS: E. coli 83972-coated urinary catheters are a viable means to achieve bladder colonization with this potentially protective strain in persons practicing ICP.