Meta-AnalysisAntimicrobial prophylaxis for urinary tract infection in persons with spinal cord dysfunction☆,☆☆,★,★★,♢,♢♢,♦
Section snippets
Literature search
We searched MEDLINE (1966-January 1998) and EMBASE (1974-January 1998) databases, using the search terms urinary tract, urinary tract infections, bacteriuria, paraplegia, quadriplegia, spinal cord injuries, multiple sclerosis, neurogenic bladder, and neuropathic bladder (free text term); case reports and animal studies were excluded. We also searched CINAHL (1982-July 1998), using analogous terms. No language restriction was applied in any search, nor was the “grey” literature such as letters
Search
The literature search yielded 4998 nonoverlapping titles from MEDLINE and EMBASE, and 255 titles from CINAHL. After reviews of titles, abstracts, and full-length articles, a total of 28 studies were identified as potentially relevant. A reference list search of those 28 articles and a survey of experts identified an additional 6 studies. Nineteen studies were excluded from the meta-analysis because they did not meet the final inclusion criteria. Figure 1 illustrates the search results, and
Clinical conclusions
Because of the high frequency of UTI or bacteriuria in persons with neurogenic bladder, assessment of the impact of prophylactic antimicrobial treatment is an important issue. Our meta-analysis of 15 controlled clinical trials does not support the claim that antimicrobial prophylaxis is associated with a reduced number of symptomatic infections among populations that have been studied. However, our analysis showed that antimicrobial prophylaxis is associated with a reduction in bacteriuria
Conclusions
Antimicrobial prophylaxis may reduce UTI among certain subgroups that our analysis was unable to investigate. In particular, prophylactic therapy may help reduce the number of infections among persons who suffer from frequent, disabling infections. This subgroup did not appear to be the target population in any of the studies we identified. Future research should focus on randomized, controlled trials in the subgroup of patients who have frequent, recurrent UTIs that limit their daily
Acknowledgements
We are grateful to Mayank Pathak, MD, Kenneth Clark, MD, Frank Lan, Michele Maines, Jeri Jackson, Zachary Edmonds, Scott Kwok, Annie Lee, and Sharon Koga for superb project assistance. Roberta Shanman, MLS, masterfully conducted the literature searches, and Caren Kamberg, MS, MPH, directed aspects of the identification of relevant literature. Tamara Breuder provided editing assistance. We also acknowledge the persons who served as advisors or reviewers for our evidence report. We also thank the
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This article is based on research conducted by the Southern California Evidence-Based Practice Center/RAND, under contract with the Agency for Healthcare Research and Quality (contract no. 290-97-001). The authors are responsible for its contents. No statement in this article should be construed as an official position of the Agency for Healthcare Research and Quality or of the US Department of Health and Human Services.
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