Effects of oral immunomodulation therapy on urinary tract infections in individuals with chronic spinal cord injury-A retrospective cohort study.
AIMS
To investigate the effect of an oral immunomodulation therapy with E. coli fractions on the frequency of urinary tract infections (UTIs) in patients with spinal cord injury (SCI) in a retrospective cohort study with a follow-up of 12 months.


METHODS
The patient database of a tertiary urologic referral center was screened for patients with chronic (>12 months) SCI who were taking a lyophilized lysate of 18 E. coli strains from 2008 to 2016. Patient characteristics, annual number of patient-reported UTIs and urine culture results were collected. The change in the number of UTIs, categorized as no UTIs, sporadic UTIs (1-2/year) and recurrent UTIs (≥3/year), from before to during immunomodulation therapy was investigated. Furthermore, the effect of different possible confounders (eg, age, duration of SCI, use of catheters, and concurrent antibiotic treatment) was investigated.


RESULTS
The data of 136 individuals with a mean age of 49 ± 14 years and a median time since SCI of 18 (15-22) years were analyzed. The proportion of patients with recurrent UTIs decreased significantly (P < 0.0001) from 93.4% (87.8-96.9%) to 59.6% (50.8-67.9%) during immunomodulation therapy, whereas the proportion of patients without UTIs increased significantly (P < 0.0001) from 2.2% (0.5-6.3%) to 20.6% (14.1-28.4%). The investigated confounders had no significant (P ≥ 0.15) effect on the outcome.


CONCLUSIONS
Oral immunomodulation therapy with E. coli fractions resulted in a significant and clinically relevant decrease in the frequency of UTIs in patients with SCI and thus, seems to be a promising option for the prevention of UTIs.
['Krebs|Jörg|J|0000-0003-1807-2670', 'Fleischli|Stefanie|S|', 'Stoyanov|Jivko|J|', 'Pannek|Jürgen|J|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D000900:Anti-Bacterial Agents D004927:Escherichia coli Infections D005260:Female D006801:Humans D056747:Immunomodulation D008297:Male D008875:Middle Aged D012189:Retrospective Studies D013119:Spinal Cord Injuries D014552:Urinary Tract Infections D055815:Young Adult
immunomodulation urinary tract infection E. coli spinal cord injury immunostimulation immunotherapy neurogenic lower urinary tract dysfunction