Morton Sally C, Shekelle Paul G, Adams John L, Bennett Carol, Dobkin Bruce H, Montgomerie John, Vickrey Barbara G
Southern California Evidence-Based Practice Center, Santa Monica, CA, USA.
Arch Phys Med Rehabil. 2002 Jan;83(1):129-38. doi: 10.1053/apmr.2002.26605.
To assess the benefits and harms of antimicrobial prophylaxis to prevent urinary tract infections (UTIs) in persons with neurogenic bladders caused by spinal cord dysfunction.
A broad search strategy with no language restriction was conducted of MEDLINE (1966-January 1998), EMBASE (1974-January 1998), and CINAHL (1982-July 1998) using the general search terms urinary tract, urinary tract infections, bacteriuria, paraplegia, quadriplegia, spinal cord injuries, multiple sclerosis, neurogenic bladder, and neuropathic bladder. Additional articles were identified by experts and by reviewing reference lists of articles obtained from searches.
Criteria included human studies of adults and adolescents who had neurogenic bladder due to spinal cord dysfunction; the studies had to address antimicrobial prophylaxis of UTI and include bacteriuria or UTI as an outcome. We excluded any study that was clearly not a controlled trial or that only included children under the age of 13 years. Two reviewers independently abstracted data, and disagreements were resolved by consensus.
Two reviewers independently abstracted data, and disagreements were resolved by consensus. Studies were graded by 1 project investigator according to quality criteria developed by Jadad and Schulz.
The sizes of the effect of antimicrobial prophylaxis on weekly infection rates from 15 trials that met the inclusion criteria were pooled by using a random effects model. Antimicrobial prophylaxis did not significantly decrease symptomatic infections. Prophylaxis was associated with a reduction in asymptomatic bacteriuria among acute patients (<90d after spinal cord injury; P <.05); 1 patient would require 3.7 weeks of treatment on average to prevent 1 asymptomatic infection. For nonacute patients, the reduction approached statistical significance (P =.06). Prophylaxis resulted in an approximately twofold increase in antimicrobial-resistant bacteria.
The regular use of antimicrobial prophylaxis for most patients who have neurogenic bladder caused by spinal cord dysfunction is not supported. A clinically important effect, however, has not been excluded. Future research should focus on randomized trials in those patients who have recurrent UTIs that limit their daily functioning and well-being.
评估抗菌药物预防对预防脊髓功能障碍所致神经源性膀胱患者发生尿路感染（UTI）的利弊。
采用广泛的检索策略，对MEDLINE（1966年 - 1998年1月）、EMBASE（1974年 - 1998年1月）和CINAHL（1982年 - 1998年7月）进行检索，检索词不受语言限制，使用的通用检索词包括泌尿道、尿路感染、菌尿症、截瘫、四肢瘫、脊髓损伤、多发性硬化、神经源性膀胱和神经性膀胱。通过专家及查阅检索所得文章的参考文献列表确定其他文章。
标准包括对因脊髓功能障碍导致神经源性膀胱的成人和青少年进行的人体研究；这些研究必须涉及UTI的抗菌药物预防，并将菌尿症或UTI作为一项结果。我们排除了任何明显不是对照试验或仅纳入13岁以下儿童的研究。两名评审员独立提取数据，分歧通过协商解决。
两名评审员独立提取数据，分歧通过协商解决。研究由1名项目研究者根据Jadad和Schulz制定的质量标准进行分级。
采用随机效应模型汇总了15项符合纳入标准的试验中抗菌药物预防对每周感染率的效应大小。抗菌药物预防并未显著降低有症状感染。预防与急性患者（脊髓损伤后<90天）无症状菌尿症的减少相关（P<.05）；平均1例患者需要接受3.7周治疗以预防1例无症状感染。对于非急性患者，减少幅度接近统计学显著性（P =.06）。预防导致耐药菌增加约两倍。
不支持对大多数因脊髓功能障碍导致神经源性膀胱的患者常规使用抗菌药物预防。然而，尚未排除具有临床重要意义的效应。未来的研究应聚焦于对日常功能和健康受复发性UTI限制的患者进行随机试验。
