膀胱內灌注稀釋優碘液可改變導尿管相關泌尿道感染對多重抗藥性細菌對抗生素的感受性

陳慧雅、何東儒、陳志碩、林威宇、黃雲慶、林健煇、黃國財、劉昱良

嘉義長庚紀念醫院 外科部 泌尿科

Diluted Iodine Aqueous Bladder Instillations Change the Antibiotic Susceptibility from Multiple Drug Resistance Microorganisms in Catheter-Associated Urinary Tract Infection

Wai-Nga Chan*, Dong-Ru Ho, Chih-Shou Chen, Wei-Yu Lin, Yun-Ching Huang, Jian-Hui Lin, Kuo-Tsai Huang, Yu-Liang Liu

Divisions of Urology, Department of Surgery, Chang Gung Medical Foundation, Chiayi City, Taiwan

Purpose: The placement of urinary catheters increased the risk of bacteriuria which can progress to a critical infection. This study aimed to determine if diluted iodine aqueous solution bladder instillations reduce the rate of symptomatic urinary tract infection (UTI) in long-term urinary catheter patients who suffer from recurrent UTIs and change the antibiotic susceptibility from multiple drug-resistant microorganisms.

Materials and Methods: We retrospectively reviewed our chart and include patients who had any medical records of outpatient visits or admission between January 1, 2015, and December 31, 2021. Inclusion criteria were patients carrying bladder urinary catheters for more than six months with available clinical data for six months before and six months after intravesical diluted iodine aqueous solution instillations. This may include both urethral catheter and cystostomy patients. The clinical data included frequency and duration of diluted iodine aqueous bladder instillation, hospitalization for urinary tract infection, organism and susceptibility test of urine culture, and usage of antibiotics. Symptomatic UTIs were defined as UTI symptoms and the need for antibiotic treatment.

Results: Six patients were included in the study. There were eighteen admissions and five were associated with catheter-related urinary tract infections. Thirty-three percent fewer admissions were noted after patients started diluted iodine aqueous bladder instillation. After bladder instillation, there were paradigm shifts in bacterial strains among all patients. In patients with bladder instillations provided by the caregivers, bacterial antibiotics sensitivity to 1st generation cephalosporin recovered, and multi-drug-resistance organisms decreased. However, patients who help themselves may have less obstructed catheters but still suffer from the progression of resistance if antibiotics were not withdrawn. The side effects of diluted iodine aqueous bladder instillation were mild and rare.

Conclusions: Diluted iodine aqueous bladder instillations decrease symptomatic UTI episodes, change the bacterial antibiotic susceptibility, and modify prevailing bacterial strains in patients with long-term urinary catheter placement who were suffering from recurrent UTIs. Though not all patients are cleared of UTIs, the majority of them will eventually have paradigm shifts in bacterial species, which remain susceptible to antibiotics.