D-甘露糖預防留置導尿相關泌尿道感染之效益：前瞻性隨機交叉試驗

曾聖修、許竣凱、吳書雨

佛教慈濟醫療財團法人台北慈濟醫院 外科部 泌尿科

D-Mannose for Preventing Catheter-Associated Urinary Tract Infections: A Prospective Randomized Crossover Trial

Shen-Shiou Tseng, Chun-Kai Hsu, Shu-Yu Wu

Divisions of Urology, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan

Purpose: Catheter-associated urinary tract infections (CAUTIs) have become one of the most common healthcare-associated infections worldwide. They account for approximately 40% of all hospital-acquired infections and 80% of nosocomial urinary tract infections (UTIs). Most urinary catheters are made of plastic materials that impair the urinary tract’s natural defense mechanisms, facilitating bacterial colonization and biofilm formation along the catheter surface, which may ultimately lead to CAUTIs.

CAUTIs are associated with increased morbidity, mortality, prolonged hospital stay, higher medical costs, and reduced quality of life. Unfortunately, to date, there are no proven effective preventive strategies other than prophylactic antibiotics. Although non-antibiotic approaches—such as probiotics, bacteriophages, and herbal therapies (e.g., cranberry juice)—have been explored, evidence supporting their efficacy remains limited.

D-mannose has demonstrated a potential protective effect against recurrent uncomplicated UTIs in women and may be as effective as antibiotics, without promoting antimicrobial resistance. The present study aimed to evaluate the effect of D-mannose in preventing CAUTIs among patients requiring long-term indwelling catheterization.

Materials and methods: We conducted a prospective, randomized, controlled comparative trial beginning on January 1, 2022. Patients with long-term indwelling urinary catheters who underwent regular monthly catheter changes and had a diagnosis of recurrent UTI in the previous year at Tzu Chi Hospital were invited to participate. After obtaining written informed consent, participants were randomly assigned to one of two groups: the D-mannose group (group 1) or the control group (group 2).

Patients in the D-mannose group received D-mannose supplementation for one year, while those in the control group continued their standard catheter care without additional intervention. After one year, participants crossed over to the opposite group for another year of follow-up. During the two-year study period, all participants were followed monthly during their scheduled catheter changes.

The primary outcome was the reduction in symptomatic UTI episodes. Secondary outcomes included asymptomatic bacteriuria episodes, positive urine cultures, catheter obstruction events, and patient-reported satisfaction.

Results: A total of 19 patients were enrolled, with 10 assigned to the group 1 (D-mannose first) and 9 to the group 2 (control group first). The two groups were comparable in baseline characteristics, including age (73.9 ± 15.7 vs 72.9 ± 12.1 years, p = 0.878), sex distribution, body mass index, duration of catheterization, and comorbidities (all p > 0.05). The main etiologies for long-term catheterization were detrusor underactivity (42.1%), bladder outlet obstruction (31.6%), and neurogenic voiding dysfunction (26.3%).

During the study period, all patients achieved 100% positive urine cultures, and there were no significant differences between the D-mannose and control periods in the use of antibiotics (25% vs 25%), catheter obstruction episodes (25% vs 25%), or mean UTI episodes per patient-month (0.36 ± 0.81 vs 1.45 ± 2.73, p = 0.223).

Longitudinal assessment of patient-reported outcomes showed no significant change in Global Response Assessment (GRA) scores over 3-, 6-, and 12-month D-mannose use (p = 0.945). Two to three patients (16.6–25%) reported subjective improvement, while most reported no change (≈ 66%), and a small minority reported worsening (≈ 8%).