1
|
Tractenberg RE, Groah SL, Frost JK, Yumoto F, Rounds AK, Ljungberg IH. Urinary Symptoms Among People With Neurogenic Lower Urinary Tract Dysfunction (NLUTD) Vary by Bladder Management. Top Spinal Cord Inj Rehabil 2023; 29:31-43. [PMID: 38076287 PMCID: PMC10644852 DOI: 10.46292/sci22-00065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Objectives To determine whether assessment and decision-making around urinary symptoms in people with neurogenic lower urinary tract dysfunction (NLUTD) should depend on bladder management. Methods Three surveys of urinary symptoms associated with NLUTD (USQNBs) were designed specific to bladder management method for those who manage their bladders with indwelling catheter (IDC), intermittent catheter (IC), or voiding (V). Each was deployed one time to a national sample. Subject matter experts qualitatively assessed the wording of validated items to identify potential duplicates. Clustering by unsupervised structural learning was used to analyze duplicates. Each item was classified into mutually exclusive and exhaustive categories: clinically actionable ("fever"), bladder-specific ("suprapubic pain"), urine quality ("cloudy urine"), or constitutional ("leg pain"). Results A core of 10 "NLUTD urinary symptoms" contains three clinically actionable, bladder-specific, and urine quality items plus one constitutional item. There are 9 (IDC), 11 (IC), and 8 (V) items unique to these instruments. One decision-making protocol applies to all instruments. Conclusion Ten urinary symptoms in NLUTD are independent of bladder management, whereas a similar number depend on bladder management. We conclude that assessment of urinary symptoms for persons with NLUTD should be specific to bladder management method, like the USQNBs are.
Collapse
Affiliation(s)
- Rochelle E. Tractenberg
- Collaborative for Research on Outcomes and –Metrics, Georgetown University, Washington, DC
- Department of Neurology, Biostatistics, Bioinformatics & Biomathematics, Georgetown University Medical Center, Washington, DC
- Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC
| | - Suzanne L. Groah
- Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC
- MedStar National Rehabilitation Hospital, Washington, DC
| | - Jamie K. Frost
- Collaborative for Research on Outcomes and –Metrics, Georgetown University, Washington, DC
| | - Futoshi Yumoto
- Collaborative for Research on Outcomes and –Metrics, Georgetown University, Washington, DC
| | - Amanda K. Rounds
- MedStar National Rehabilitation Hospital, Washington, DC
- MedStar Health Research Institute, Hyattsville, MD
| | - Inger H. Ljungberg
- MedStar National Rehabilitation Hospital, Washington, DC
- MedStar Health Research Institute, Hyattsville, MD
| |
Collapse
|
2
|
Kyser AJ, Mahmoud MY, Johnson NT, Fotouh B, Steinbach-Rankins JM, Gilbert NM, Frieboes HB. Development and Characterization of Lactobacillus rhamnosus-Containing Bioprints for Application to Catheter-Associated Urinary Tract Infections. ACS Biomater Sci Eng 2023. [PMID: 37367532 DOI: 10.1021/acsbiomaterials.3c00210] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Catheter-associated urinary tract infections (CAUTI) are a significant healthcare burden affecting millions of patients annually. CAUTI are characterized by infection of the bladder and pathogen colonization of the catheter surface, making them especially difficult to treat. Various catheter modifications have been employed to reduce pathogen colonization, including infusion of antibiotics and antimicrobial compounds, altering the surface architecture of the catheter, or coating it with nonpathogenic bacteria. Lactobacilli probiotics offer promise for a "bacterial interference" approach because they not only compete for adhesion to the catheter surface but also produce and secrete antimicrobial compounds effective against uropathogens. Three-dimensional (3D) bioprinting has enabled fabrication of well-defined, cell-laden architectures with tailored release of active agents, thereby offering a novel means for sustained probiotic delivery. Silicone has shown to be a promising biomaterial for catheter applications due to mechanical strength, biocompatibility, and its ability to mitigate encrustation on the catheter. Additionally, silicone, as a bioink, provides an optimum matrix for bioprinting lactobacilli. This study formulates and characterizes novel 3D-bioprinted Lactobacillus rhamnosus (L. rhamnosus)-containing silicone scaffolds for future urinary tract catheterization applications. Weight-to-weight (w/w) ratio of silicone/L. rhamnosus was bioprinted and cured with relative catheter dimensions in diameter. Scaffolds were analyzed in vitro for mechanical integrity, recovery of L. rhamnosus, antimicrobial production, and antibacterial effect against uropathogenic Escherichia coli, the leading cause of CAUTI. The results show that L. rhamnosus-containing scaffolds are capable of sustained recovery of live bacteria over 14 days, with sustained production of lactic acid and hydrogen peroxide. Through the use of 3D bioprinting, this study presents a potential alternative strategy to incorporate probiotics into urinary catheters, with the ultimate goal of preventing and treating CAUTI.
Collapse
Affiliation(s)
- Anthony J Kyser
- Department of Bioengineering, University of Louisville Speed School of Engineering, Louisville, Kentucky 40202, United States
| | - Mohamed Y Mahmoud
- Department of Bioengineering, University of Louisville Speed School of Engineering, Louisville, Kentucky 40202, United States
- Department of Toxicology and Forensic Medicine, Faculty of Veterinary Medicine, Cairo University, Giza 12613, Egypt
| | | | - Bassam Fotouh
- Department of Bioengineering, University of Louisville Speed School of Engineering, Louisville, Kentucky 40202, United States
| | - Jill M Steinbach-Rankins
- Formerly at: Department of Bioengineering and Center for Predictive Medicine, University of Louisville Speed School of Engineering, Louisville, Kentucky 40202, United States
| | - Nicole M Gilbert
- Department of Pediatrics, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri 63110, United States
- Center for Women's Infectious Disease Research, Washington University School of Medicine, St. Louis, Missouri 63110, United States
| | - Hermann B Frieboes
- Department of Bioengineering, University of Louisville Speed School of Engineering, Louisville, Kentucky 40202, United States
- Center for Predictive Medicine, University of Louisville, Louisville, Kentucky 40202, United States
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, Kentucky 40202, United States
- UofL Health─Brown Cancer Center, University of Louisville, Louisville, Kentucky 40202, United States
| |
Collapse
|
3
|
Watson RA. Enlisting Probiotics to Combat Recurrent Urinary Tract Infections in Women-A Military Strategy for Meeting the Challenge. Antibiotics (Basel) 2023; 12:antibiotics12010167. [PMID: 36671368 PMCID: PMC9854529 DOI: 10.3390/antibiotics12010167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/08/2023] [Accepted: 01/09/2023] [Indexed: 01/15/2023] Open
Abstract
For decades, the potential role of probiotics in the prevention and treatment of recurrent urinary tract infections has been extensively studied. However, achieving an effective problem-solving strategy has thus far proven elusive. Perhaps adopting a military paradigm might expedite our assault on chronic, recurring bacteriuria in women. What is needed is a targeted strategy with specific attention to (1) the enemy: the case-specific uropathogen; (2) the battlefield: the extraordinarily complex interplay of factors within the bladder, unique to a given patient, which interface with profoundly important influences from the gut biome, as well as the vaginal biota; (3) the weapon: an antimicrobial probiotic with demonstrated activity against that specific uropathogen; (4) a new strategy: taking these complexities into account, we posit a key role for the instillation of case-specific lactobacilli directly into the bladder of the designated patient. This newly proposed, targeted intervention might be termed "Probiotic Intravesical Organic Therapy-PIVOT"; and (5) the long campaign: reaching clinically proven success may entail a long campaign. However, already, on many fronts, the elements necessary for victory recently seem to be falling into place.
Collapse
|
4
|
Groah SL, Tractenberg RE. Intravesical Lactobacillus rhamnosus GG versus Saline Bladder Wash: Protocol for a Randomized, Controlled, Comparative Effectiveness Clinical Trial. Top Spinal Cord Inj Rehabil 2022; 28:12-21. [PMID: 36457355 PMCID: PMC9678213 DOI: 10.46292/sci22-00005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background Complicated urinary tract infection (cUTI) is pervasive and costly among people with spinal cord injury (SCI) and neurogenic lower urinary tract dysfunction (NLUTD). Objectives To describe the protocol for a comparative effectiveness randomized controlled trial of intravesical Lactobacillus rhamnosus GG (LGG) versus saline bladder wash (BW) for self-management of urinary symptoms. Methods Comparative effectiveness trial of self-administered LGG versus saline bladder wash among 120 participants with SCI+NLUTD at least 6 months post SCI. The study has both treatment and prophylaxis phases. After predictive enrichment at screening, randomized participants will enter the treatment phase (6 months) in which they instill either LGG or normal saline after trigger symptoms occur (more cloudy or more foul-smelling urine). In the prophylaxis phase (6 months), participants will instill their respective intervention every 3 days after the first occurrence of trigger symptoms. Results Study results will provide a comparison of effects on Urinary Symptom Questionnaire for Neurogenic Bladder (USQNB) bladder and urine symptoms and episodes of "presumed UTIs"; number of days antibiotics were used (both self-reported); days of work, school, rehabilitation, or other activity lost due to urinary symptoms; engagement with the health care system; number of instillations; satisfaction; and safety. Conclusion cUTI is a variable clinical entity. Unlike clinical trials that assume a single, simple entity (UTI) in inclusion or outcome criteria, this protocol targets the mechanisms underlying cUTI causes and phenotypes. Featuring reliable and valid outcome measures with analytic methods specifically appropriate for quantifying self-report, patient self-management, inclusion of both intervention and prophylactic phases, and predictive enrichment, these design elements may be adopted for future research.
Collapse
Affiliation(s)
- Suzanne L. Groah
- MedStar National Rehabilitation Hospital, Washington, DC
- MedStar Georgetown University Hospital, Washington, DC
| | - Rochelle E. Tractenberg
- Collaborative for Research on Outcomes and Metrics, and Departments of Neurology, Biostatistics, Bioinformatics & Biomathematics, and Rehabilitation Medicine, Georgetown University, Washington, DC
| |
Collapse
|
5
|
Kawalec A, Zwolińska D. Emerging Role of Microbiome in the Prevention of Urinary Tract Infections in Children. Int J Mol Sci 2022; 23:870. [PMID: 35055056 PMCID: PMC8775962 DOI: 10.3390/ijms23020870] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/03/2022] [Accepted: 01/12/2022] [Indexed: 02/04/2023] Open
Abstract
The microbiome of the urinary tract plays a significant role in maintaining health through the impact on bladder homeostasis. Urobiome is of great importance in maintaining the urothelial integrity and preventing urinary tract infection (UTI), as well as promoting local immune function. Dysbiosis in this area has been linked to an increased risk of UTIs, nephrolithiasis, and dysfunction of the lower urinary tract. However, the number of studies in the pediatric population is limited, thus the characteristic of the urobiome in children, its role in a child's health, and pediatric urologic diseases are not completely understood. This review aims to characterize the healthy urobiome in children, the role of dysbiosis in urinary tract infection, and to summarize the strategies to modification and reshape disease-prone microbiomes in pediatric patients with recurrent urinary tract infections.
Collapse
Affiliation(s)
- Anna Kawalec
- Clinic of Pediatric Nephrology, University Hospital, 50-556 Wroclaw, Poland
| | - Danuta Zwolińska
- Department of Pediatric Nephrology, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| |
Collapse
|
6
|
Ziadeh T, Chebel R, Labaki C, Saliba G, Helou EE. Bladder instillation for urinary tract infection prevention in neurogenic bladder patients practicing clean intermittent catheterization: A systematic review. Urologia 2021; 89:261-267. [PMID: 34612750 DOI: 10.1177/03915603211049883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the efficacy and safety of different modalities of bladder instillation in patients with neurogenic bladder practicing intermittent catheterization. METHODS A systematic review of the literature were conducted using two databases: Medline via PubMed and Scopus. Articles evaluating bladder instillation in patients with neurogenic bladder, who are practicing intermittent catheterization, were collected and assessed for the efficacy and safety of the studied agent by two different reviewers. RESULTS Among the 1896 studies, eight involving 346 patients with neurogenic bladder, were included in this systematic review according to the PRISMA protocols. Gentamicin, Hyaluronic acid, and Lactobacillus rhamnosus was found to decrease the incidence of urinary tract infections, the former reduced multidrug-resistant organisms. Kanamycin-colistin, showed a drop in the mean incidence of bacteriuria in males only. Trisdine, the only studied antiseptic, significantly reduced bacteriuria. Neomycin, however, showed no efficacy in term of bacteriuria. Regarding safety, when evaluated, no major adverse events were reported with any of the studied modalities. CONCLUSION Bladder instillations of either antibiotics, antiseptics, hyaluronic acid, or Lactobacillus rhamnosus GG are efficient and safe in patients having neurogenic bladder, with recurrent urinary tract infections and practicing clean intermittent catheterization, with gentamicin being the most recommended product among the different studied agents.
Collapse
Affiliation(s)
- Talal Ziadeh
- Department of Urology, Hôtel-Dieu de France, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Roy Chebel
- Department of Urology, Hôtel-Dieu de France, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Chris Labaki
- Department of Urology, Hôtel-Dieu de France, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Gebrael Saliba
- Department of Infectious Diseases, Hôtel-Dieu de France, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Elie El Helou
- Department of Urology, Hôtel-Dieu de France, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| |
Collapse
|
7
|
Validity of the Urinary Symptom Questionnaires for people with neurogenic bladder (USQNB) who void or use indwelling catheters. Spinal Cord 2021; 59:948-958. [PMID: 34349234 DOI: 10.1038/s41393-021-00666-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Descriptive Psychometrics Study OBJECTIVES: Neurogenic lower urinary tract dysfunction (NLUTD), or "neurogenic bladder" is a common and disruptive condition for individuals with spinal cord injury (SCI) and disease (including multiple sclerosis, MS). Our team has developed patient-centered instruments of urinary symptoms specific to patients with NLUTD, across bladder management methods. Validity evidence is needed to support the use of two new instruments, Urinary Symptom Questionnaires for people with Neurogenic Bladder (USQNB) for those who manage their bladder with indwelling catheters (IDC), or who void (V). SETTING Online surveys completed by individuals in the United States with NLUTD due to either SCI or MS who manage their bladder with indwelling catheters (SCI, n = 306; MS, n = 8), or by voiding (SCI, n = 103; MS, n = 383). A total of n = 381 USQNB-IDC respondents (five control groups), and 351 USQNB-V respondents (four control groups), contributed to our convergent and divergent validity evidence. METHODS Data were collected online to estimate key aspects of psychometric validity (content, reflection of the construct to be measured; face, recognizability of the contents as representing the construct to be measured; structural, the extent to which the instrument captures recognizable dimensions of the construct to be measured). Divergent and convergent validity evidence was derived from multiple control groups, while evidence of criterion validity was derived from attribution of each item to their experience "with a UTI". RESULTS Evidence of face, content, criterion, convergent, and divergent validity was compiled for each instrument. CONCLUSIONS The instruments demonstrate adequate, multi-dimensional, validity evidence to recommend their use for decision-making by patients, clinicians, and researchers.
Collapse
|
8
|
Forster CS, Hsieh MH, Cabana MD. Perspectives from the Society for Pediatric Research: Probiotic use in urinary tract infections, atopic dermatitis, and antibiotic-associated diarrhea: an overview. Pediatr Res 2021; 90:315-327. [PMID: 33288875 PMCID: PMC8180529 DOI: 10.1038/s41390-020-01298-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 02/08/2023]
Abstract
Probiotics have received significant attention within both the scientific and lay communities for their potential health-promoting properties, including the treatment or prevention of various conditions in children. In this article, we review the published data on use of specific probiotic strains for three common pediatric conditions: the prevention of urinary tract infections and antibiotic-associated diarrhea and the treatment of atopic dermatitis. Research into the utility of specific probiotic strains is of varying quality, and data are often derived from small studies and case series. We discuss the scientific merit of these studies, their overall findings regarding the utility of probiotics for these indications, issues in reporting of methods, and results from these clinical trials, as well as future areas of investigation.
Collapse
Affiliation(s)
- Catherine S. Forster
- grid.239560.b0000 0004 0482 1586Department of Pediatrics, Children’s National Health System, Washington, DC USA
| | - Michael H. Hsieh
- grid.239560.b0000 0004 0482 1586Department of Pediatrics, Children’s National Health System, Washington, DC USA
| | - Michael D. Cabana
- grid.251993.50000000121791997Department of Pediatrics, Children’s Hospital at Montefiore and the Albert Einstein School of Medicine, Bronx, NY USA
| |
Collapse
|