Multidrug-resistant Uro-associated Populations and Recurrent Urinary Tract Infections in Patients Performing Clean Intermittent Self-catheterisation.

BACKGROUND

The AnTIC trial linked continuous low-dose antibiotic prophylaxis treatments to a lower incidence of symptomatic urinary tract infections (UTIs) among individuals performing clean intermittent self-catheterisation (CISC).

OBJECTIVE

To explore potential mechanisms underlying the protective effects of low-dose antibiotic prophylaxis treatments, blood and urine samples and uro-associated isolates from AnTIC participants were analysed.

DESIGN SETTING AND PARTICIPANTS

Blood samples ( = 204) were analysed for gene polymorphisms associated with UTI susceptibility and multiple urine samples ( = 558) were analysed for host urogenital responses. sequence data for 45 temporal isolates recovered from the urine samples of 16 trial participants in the prophylaxis ( = 9) and no-prophylaxis ( = 7) study arms, and characterised by multidrug resistance (MDR), were used to classify individual strains.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

polymorphism data were analysed using Poisson regression. Concentrations of urine host defence markers were analysed using linear mixed-effects models, which accounted for repeated urine samples.

RESULTS AND LIMITATIONS

Urine samples from CISC users, irrespective of antibiotic treatment regimens, were associated with robust urothelial innate responses. No links were identified between genotype and CISC user susceptibility to recurrent UTIs. Microbiological study data were limited to the predominant MDR population; participants prescribed low-dose prophylactic antibiotics were predominantly colonised by a single uro-associated strain, while participants given acute antibiotic treatments were each colonised by more than one strain.

CONCLUSIONS

Antibiotic treatments did not impact urogenital responses to infection in CISC users. Host genetics in terms of polymorphisms played no role in determining CISC user susceptibility to or protection from recurrent UTIs. Prophylactic antibiotic treatments associated with MDR were associated with colonisation by stable uro-associated genotypes.

PATIENT SUMMARY

Our findings show that the natural urogenital defences of clean intermittent self-catheterisation (CISC) users were not impacted by antibiotic treatments. For some CISC users, prophylaxis with low-dose antibiotics selected for a stable, predominantly, rich uromicrobiota.