A study protocol has caught my eye this week, a trial of oral probiotics vs placebo as prophylaxis for UTI in spinal cord patients, a very high risk group for these infections and associated complications. It will be a multi-site randomised double-blind double-dummy placebo-controlled factorial design study running over 24 weeks conducted in New South Wales, Australia. Probably about as robust as it gets scientifically.The authors cite a review from 10 years ago that suggested that restoration of the female vaginal flora may have beneficial effects in reducing recurrent UTIs, noting that probiotics have an excellent safety profile. In a landmark recommendation the authors recommended further studies be done.. Sadly not many have been published. I will look forward to the publication of the results of this study (whichever way it goes) with some interest, particularly those relating to MDRO colonisation, for which this is a high-prevalence group. Although the primary outcome of interest is the prevention of UTI, a number of the secondary outcomes are also of interest, including how probiotic intervention affects microbial community composition in the urine and urinary catheter and what are the differences between microbial communities in individuals who are symptomatic versus asymptomatic for UTI. The biofilms present in the catheters will also be examined and I hope that the authors will also examine encrustation and blockage when they consider this aspect of the work. Anything that has the potential to reduce the burden of antibiotic use should be seriously looked at, especially if follow-up work could look more widely at long-term catheters, a hugely understudied area.
Reflections on Infection Prevention and Control 
Very interesting Report
LikeLike
Probiotics represent a very interesting “flip side of the coin” to more conventional approaches in healthcare.
The concept of populating an “environment” with beneficial bacteria to “out compete” more harmful, pathogen bacteria is one that has a lot of potential; much more so than the use of phage approaches.
Probiotic bacteria based cleaning agents have proven amazingly successful in the agricultural livestock operations, and have been critical in the transition to Antibiotic Free livestock operations.
The concept is quite simple; by cleaning facilities with probiotic cleaners, a process whereby probiotic bacteria are introduced in combination with surfactants into the environment being cleaned in such numbers that they out compete the pathogens for the available food source. This in turn starves the pathogens to death, thus eliminating them in a manner that fails to trigger any possible path of mutation, (no living thing has been able to mutate to survive starvation). At the same time a preventative layer of probiotics is left on the surface so as to inhibit the re-colonization of pathogens and so the regeneration of their associated biiofilm.
So if probiotics can be effective in positively impacting the bacterial community in high pathogen contaminated livestock facilities, then I believe that they can be selected and appropriately introduced into other “environments” to produce similar beneficial results.
LikeLiked by 1 person
Thanks Martin – interesting. What’s in the probiotic? And how is it applied in a way that it can get to the UT?
LikeLike
Given that one of the side effects of probiotics can be diarrhoea, all be it limited, it will be interesting to see if the probiotics increase the risk of UTI in this group who will have limited bowel control.
Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
PO Box 5202
Middle Park
Victoria, 3206
Australia
M: +61 404 816 434
infexion@ozemail.com.au
Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
PO Box 5202
Middle Park
Victoria, 3206
Australia
M: +61 404 816 434
infexion@ozemail.com.au
ABN 47533508426
LikeLike
the information is so resourceful and has increased my knowledge alot.
LikeLike