Comparison of Three Different Antibiotic Treatments Against Recurrent Urinary Tract Infections in Catheterized Patients
Study Details
Study Description
Brief Summary
Recurrent urinary tract infections (UTI) in the patients chronically catheterized are serious challenges clinically. The pathogens are often multidrug-resistant bacteria and such UTIs are actually biofilm infections. Currently standard antibiotic treatment against UTI in Denmark is sensitive antibiotic monotherapy. Theoretically antibiotic monotherapy is not a good treatment against biofilm infections. In the patients with impaired renal functions, both i.v. and p.o. antibiotic treatments function poor. Therefore, bladder lavage might help. In the study, the participants will be randomly divided into three groups (monotherapy, combination and bladder lavage). The investigators will evaluate the results and find a better treatment based on the clinical evidences, which might benefit the patients.
Condition or Disease | Intervention/Treatment | Phase |
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Detailed Description
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 induction of 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 "https://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. The investigators intends to observe and compare both treatments and try to clarify their respective advantages and disadvantages, which will benefit the 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). The investigators will evaluate the results and find a better treatment based on the clinical evidences, which might benefit the patients.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Experimental: Antibiotic monotherapy Single antibiotic is given intravenously or orally (systemically). |
Combination Product: Antibiotic combination therapy
Anti-infective treatment with at least two different types of sensitive antibiotics.
Other Names:
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Experimental: Antibiotic combination therapy At least two different antibiotics are given intravenously or orally. |
Combination Product: Antibiotic combination therapy
Anti-infective treatment with at least two different types of sensitive antibiotics.
Other Names:
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Experimental: Topical antibiotic therapy Single antibiotic bladder irrigation. |
Combination Product: Antibiotic combination therapy
Anti-infective treatment with at least two different types of sensitive antibiotics.
Other Names:
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Outcome Measures
Primary Outcome Measures
- Infection control [3 days]
Local UTI symptoms (cloudy urine, hematuria, smelly urine, discomfort or pain in the lower abdomen or pubic symphysis) were significantly reduced or disappeared.
- Infection control [Less than 3 days]
Higher body temperature (more than 37.5 degrees) recover to normal (between 36 - 37 degrees).
- Infection control [Less than or equal to 5 days]
Blood leukocyte count reduced from more than 8,800 × 109/L (dominated by neutrophils) to between 4,000 to 8,800 x 109/L.
- Infection control [Less than or equal to 5 days]
C-reactive protein (CRP) reduced from significantly higher than 10 mg/L to less than 10 mg/L.
- Infection control [Less than or equal to 5 days]
Estimated glomerular filtration rate (eGFR) recovered from less than 60 mL/min/1,73 m2 to equal to 60 or higher.
Secondary Outcome Measures
- UTI recurrence expectation [One month]
Significant less UTI recurrence.
Eligibility Criteria
Criteria
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 UTI (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.
Contacts and Locations
Locations
No locations specified.Sponsors and Collaborators
- University of Southern Denmark
- Hospital of South West Jutland
Investigators
None specified.Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- Projekt-ID: S-20190083G CSF