Sandock D S, Gothe B G, Bodner D R
Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA.
Paraplegia. 1995 Mar;33(3):156-60. doi: 10.1038/sc.1995.34.
Suppressive therapy with antibiotics has long been thought to decrease the number of complications from the neuropathic bladder in spinal cord injury patients, but it may also induce resistance to antibiotics which subsequently causes difficulties in treating symptomatic urinary tract infections. Forty-three chronic spinal cord injury patients were randomized to continue to receive daily trimethoprim-sulfamethoxazole (TMP-SMX) urinary tract prophylaxis versus discontinuing antibiotic prophylaxis. Patients were all at least 6 months after spinal cord injury. Patients were followed for a minimum of 3 months, with weekly catheter urine cultures. The difference in the colonization rate at onset and after 3 months (percent of cultures with asymptomatic bacteriuria) between the control and prophylaxis group was not statistically significant (P > 0.1). There was a significant decrease in the percentage of TMP-SMX resistant asymptomatic bacteriuria in the control group, 78.8%, compared to 94.1% in the suppressive group (P < 0.05). There was no significant difference in the number of symptomatic urinary tract infections following the withdrawal of suppressive therapy between the control group, 0.035/week, and the prophylaxis group, 0.043/week (P > 0.5). There was a larger percentage of TMP-SMX resistant symptomatic urinary tract infections in the treated group, 42.5% versus 37.5% in the control group, but the difference was not significant (P > 0.5). Irrespective of the method of bladder management, suppressive therapy with TMP-SMX did not reduce the incidence of symptomatic bacteriuria and did increase the percentage of cultures resistant to TMP-SMX in asymptomatic patients.
长期以来，人们一直认为使用抗生素进行抑制性治疗可减少脊髓损伤患者神经源性膀胱的并发症数量，但这也可能导致对抗生素产生耐药性，进而在治疗有症状的尿路感染时造成困难。43例慢性脊髓损伤患者被随机分为两组，一组继续每日接受甲氧苄啶-磺胺甲恶唑（TMP-SMX）进行尿路预防，另一组停止使用抗生素预防。所有患者均在脊髓损伤至少6个月后。对患者进行了至少3个月的随访，每周进行一次导尿管尿液培养。对照组和预防组在开始时和3个月后的定植率（无症状菌尿培养的百分比）差异无统计学意义（P>0.1）。对照组中对TMP-SMX耐药的无症状菌尿百分比显著下降，为78.8%，而抑制组为94.1%（P<0.05）。在停止抑制性治疗后，对照组有症状的尿路感染发生率为0.035/周，预防组为0.043/周，两组之间差异无统计学意义（P>0.5）。治疗组中对TMP-SMX耐药的有症状尿路感染百分比更高，为42.5%，而对照组为37.5%，但差异无统计学意义（P>0.5）。无论膀胱管理方法如何，使用TMP-SMX进行抑制性治疗均未降低有症状菌尿的发生率，且确实增加了无症状患者中对TMP-SMX耐药的培养物百分比。
