Tofte Nete, Nielsen Alex C Y, Trøstrup Hannah, Andersen Christine B, Von Linstow Michael, Hansen Birgitte, Biering-Sørensen Fin, Høiby Niels, Moser Claus
Department of Clinical Microbiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Department of Clinical Microbiology, Hvidovre Hospital, Copenhagen University Hospital, Copenhagen, Denmark.
APMIS. 2017 Apr;125(4):385-391. doi: 10.1111/apm.12685.
Patients suffering from spinal cord injuries resulting in complete or incomplete paraplegia or tetraplegia are highly disposed to frequent, recurrent or even chronic urinary tract infections (UTIs). The reason for the increased risk of acquiring UTIs is multifactorial, including reduced sensation of classical UTI symptoms, incomplete bladder emptying, frequent catheterizations or chronic urinary tract catheters. Biofilms in relation to UTIs have been shown both on catheters, on concrements or as intracellular bacterial communities (IBCs). Due to the increased risk of acquiring recurrent or chronic UTIs and frequent antibiotic treatments, patients experience an increased risk of being infected with antibiotic-resistant bacteria like extended-spectrum β-lactamase-producing Escherichia coli or Klebsiella spp., but also bacteria like Pseudomonas aeruginosa inherently resistant to several antibiotics. Diagnosing the UTI can also be challenging, especially distinguishing harmless colonization from pathogenic infection. Based on a previous study showing activation of humoral immune response toward UTI pathogens in patients with spinal cord lesions (SCL), the present mini review is an evaluation of using antibody response as an indicator of chronic biofilm UTI. In addition, we evaluated the effect of long-term treatment with antibiotics in patients with SCLs and chronic UTI, defined by culturing of a uropathogen in the urine and elevated specific precipitating antibodies against the same uropathogen in a blood sample. Elimination of chronic UTI, decrease in specific precipitating antibody values and avoiding selection of new multidrug-resistant (MDR) uropathogens were the primary markers for effect of treatment. The results of this evaluation suggest that the long-term treatment strategy in SCL patients with chronic UTI may be effective; however, randomized prospective results are needed to confirm this.
患有脊髓损伤导致完全或不完全截瘫或四肢瘫的患者极易频繁、反复甚至慢性发生尿路感染（UTIs）。发生UTIs风险增加的原因是多方面的，包括对经典UTI症状的感觉减退、膀胱排空不完全、频繁导尿或长期留置导尿管。与UTIs相关的生物膜已在导尿管、结石上或作为细胞内细菌群落（IBCs）被发现。由于反复或慢性UTIs风险增加以及频繁使用抗生素治疗，患者感染产超广谱β-内酰胺酶大肠杆菌或克雷伯菌属等耐抗生素细菌的风险增加，同时也会感染对多种抗生素固有耐药的铜绿假单胞菌等细菌。UTIs的诊断也可能具有挑战性，尤其是区分无害定植与致病性感染。基于先前一项研究显示脊髓损伤（SCL）患者对UTI病原体的体液免疫反应激活，本综述评估了将抗体反应用作慢性生物膜UTI指标的情况。此外，我们评估了对SCL和慢性UTI患者长期使用抗生素治疗的效果，慢性UTI定义为尿液中培养出尿路病原体且血样中针对同一尿路病原体的特异性沉淀抗体升高。消除慢性UTI、降低特异性沉淀抗体值以及避免选择新的多重耐药（MDR）尿路病原体是治疗效果的主要指标。该评估结果表明，SCL慢性UTI患者的长期治疗策略可能有效；然而，需要随机前瞻性结果来证实这一点。
