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Actas Urol Esp. 2012;36(8):482---483
Actas Urológicas Españolas
www.elsevier.es/actasuro
COMMENTARY
Comment to «Urinary infection in patients with neurogenic
bladder: Patterns of resistance to the most frequent
uropathogens»夽
Comentario a: «Infección urinaria en pacientes con vejiga neurógena:
consideraciones sobre el tratamiento antibiótico»
A. Pérez-Ayala a , J.I. Alós a,b,∗
a
b
Servicio de Microbiología, Hospital Universitario de Getafe, Getafe, Madrid, Spain
Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
Neurogenic bladder patients present a high risk of urinary tract infection (UTI), mainly because they often
require invasive methods for urination. The incidence
of UTIs in patients with neurogenic bladder is 2.5
infections/patient/year.1 It is very common to observe
these infections in long-stay centers or in primary
care/emergency. Although they do not usually have UTIs as
a consequence of hospitalization, these patients have very
similar characteristics to those with nosocomial UTIs, and
they are considered complicated UTIs because they occur in
patients with underlying urological pathology.2
The most common microorganism is, as in the
UTIs acquired in the community without risk factors,
Escherichia coli. But if the patient has an indwelling bladder
catheter, the frequency of other Gram-negative bacilli more
resistant to antibiotics and of enterococci increases.
The antibiotic pressure suffered by these patients being
exposed to long and repeated cycles of antibiotics leads
to increased risk of infection by multiresistant bacteria, so
the empirical treatment of this type of infections becomes
complicated.
夽 Please cite this article as: Pérez-Ayala A, Alós JI. Comentario
a: «Infección urinaria en pacientes con vejiga neurógena: consideraciones sobre el tratamiento antibiótico». Actas Urol Esp.
2012;36:482---3.
∗ Corresponding author.
E-mail address: nachoalos@telefonica.net (J.I. Alós).
An important step prior to the need for antibiotic treatment is the prevention of the infection, the use of closed
system catheter, and removal thereof as soon as possible
being essential in this type of patients. Antibiotic prophylaxis is generally not recommended due to the potential side
effects, the high cost, and the risk of selecting multiresistant
microorganisms.2
The antibiotic treatment will depend on the severity
of the patient and the risk of multiresistant microorganisms. It is important to always request urine culture and
antibiogram, and base the empirical treatment on the
local data of antibiotic sensitivity that the microbiologists
should provide to the clinicians interested periodically.3
Subsequently, the empirical therapy should adjust to the
specific bacteria identified in the urine culture. The study
by Romero-Cullerés et al.4 provides recent local data of
sensitivity to antibiotics in this population group, clearly distinct from those of other population groups also studied by
them.
The spread of resistance to antibiotics threatens the
advances achieved in many areas of the fight against
infectious diseases. We know that an appropriate use of
antibiotics delays the dissemination of resistance. It is
recommended to diversify the antibiotic treatments to
dilute the selective pressure and prevent the accumulation of resistances,5 to which the use of antibiotics such
as fosfomycin, with a high percentage of sensitivity in
E. coli, and which is seldom used for other infections,
helps.
2173-5786/$ – see front matter © 2012 AEU. Published by Elsevier España, S.L. All rights reserved.
Documento descargado de http://www.elsevier.es el 17/11/2016. Copia para uso personal, se prohíbe la transmisión de este documento por cualquier medio o formato.
Comment to «Urinary infection in patients with neurogenic bladder
References
1. Siroky MB. Pathogenesis of bacteriuria and infection in the
spinal cord injured patient. Am J Med. 2002;113 Suppl.
1A:67S.
2. García-Leoni ME, Esclarín de Ruz A. Management of urinary tract
infection in patients with spinal cord injuries. Clin Microbiol
Infect. 2003;9:780---5.
483
3. Livermore DM, Pearson A. Antibiotic resistance: location, location, location. Clin Microbiol Infect. 2007;13 Suppl. 2:7---16.
4. Romero-Cullerés G, Planells-Romeo I, Martinez de Salazar-Muñoz
P, Conejero-Sugrañes J. Infección urinaria en vejiga neurógena:
patrones de resistencias de los uropatógenos más frecuentes.
Actas Urol Esp. 2012;36:474---81.
5. Lipsitch M, Levin BR. The population dynamics of antimicrobial
chemotherapy. Antimicrob Agents Chemother. 1997;41:363---73.