Madeleine Wikström, Richard Levi, Wolfram Antepohl
Clinical Department of Rehabilitation Medicine, Region Östergötland, SE-58185 Linköping, Sweden. E-mail: madeleine.wikstrom@regionostergotland.se
DOI: 10.2340/16501977-2298

Objective: To explore whether bladder irrigation with chlorhexidine: (i) can reduce bacteriuria, and (ii) is a practically feasible option in subjects with spinal cord injury practicing intermittent self-catheterization.
Design: A prospective, non-controlled, open, multi-centre study.
Methods: Fifty patients with spinal cord injury, practicing intermittent self-catheterization, with a history of recurrent urinary tract infections were screened for bacteriuria at follow-up visits to 4 spinal cord injury centres in Sweden. Twenty-three patients had a positive urine culture (> 105 CFU/ml of > 1 bacterial species), of which 19 completed the study. Subjects proceeded with bladder irrigation, using 120 ml of 0. 2% chlorhexidine solution twice daily for up to 7 days. Urine samples were taken twice daily. Response to treatment was defined as reduction in bacterial counts to < 103 CFU/ml.
Results: Fourteen of 19 subjects reduced their bacterial counts to or below the set limit. Subsequent return of above-endpoint bacteriuria was seen in most of the subjects. However, there were significantly fewer subjects with bacteriuria after treatment (p < 0. 005).
Conclusion: Bladder irrigation with chlorhexidine, using intermittent self-catheterization, reduced bacteriuria in the majority of subjects with spinal cord injury and bacteriuria. The addition of bladder irrigation was practically feasible in the short time-frame of this study.

People with spinal cord injury often suffer from loss of control over bladder function and hence need to empty their bladder using catheters. Preferably, this is done by regularly inserting a catheter, so called “clean intermittent catheterization”, instead of using an indwelling catheter. Although this method is less prone to cause urinary tract infections (UTI), bacteria may still grow in the bladder and UTI often are a frequent problem. Even if it is not sure that the presence of bacteria in the bladder actually leads to UTI, we wanted to see whether the amount of bacteria could be reduced using an antiseptic agent called Chlorhexidine to cleanse the bladder. 19 patients with bacterial growth in the bladder completed a study using chlorhexidine on a daily basis. 14 of those patients reduced the number of bacteria significantly. Our conclusion is that cleansing the bladder using chlorhexidine is a feasible method to reduce bacterial load in the bladder. More research is needed to clarify whether this even leads to a reduction in the frequency of urinary tract infections.