Michael van Straten
Michael van Straten

Probiotics Help Prevent Urinary Tract Infections

As a student I spent a lot of time working at Stoke Mandeville Hospital, in fact I helped with one of the first ever International Paraplegic Games. A very primitive affair with the athletes living in Nissan huts, much late night fun in the local pubs and a tremendous sense of excitement when Prince Phillip landed in a helicopter – this was in in the late 1950s!

Not surprisingly I was fascinated to read the following interview with Dr Wong, especially as one of the areas I worked in was the avoidance of urinary infections caused by catheters – no one knew about probiotics then.

Dr Wong investigated whether a probiotic (a fermented milk drink containing Lactobacillus casei Shirota) could help reduce incidence of antibiotic-associated diarrhoea (AAD) and Clostridium difficile-associated diarrhoea (CDAD) in patients at Stoke Mandeville.

164 patients recently prescribed antibiotics were randomly given either probiotic or no probiotic. The probiotic was given once daily during antibiotic use and for seven days afterwards. The probiotic group had much less diarrhoea compared to the control group 17.1% as opposed to 52.9%.

Dr Samford Wong is Clinical Lead Dietician and Research Associate at the National Spinal Injuries Centre at Stoke Mandeville Hospital. He was awarded the Spinal Cord Prize by the International Spinal Cord Society in November 2012 for his research, and has received recognition from the Healthcare Infection Society.

At the International Yakult Symposium, he presented results from a recent probiotic study at Stoke Mandeville Hospital. We had the chance to chat with him at the symposium to find out more.
Q. What sparked your interest in patients with spinal cord injuries (SCI)?

A. I like calculations. I do research in a way that I can prove there is a solution to improve a patient’s quality of care. I have an interest in helping to improve the lives of SCI patients as they face overwhelming lifestyle changes.

Q. The majority of SCIs occur as a consequence of road traffic accidents (RTAs) and falls. Do you think this is why around 80% of these patients are male?

A. Partly, yes. RTAs (including motorcycle accidents) commonly involve men – as do surfing accidents in the summer and skiing accidents in the winter; both predominantly male hobbies. Obviously, wearing a seatbelt is the best prevention of SCI in RTAs. The majority of SCIs caused by ‘falls’ are actually in older people.

Q; Can you describe your patients and their quality of life?
A; Quality of life is a large area of research. The average stay in SCI centres is six months. At Stoke Mandeville Hospital, patients are encouraged to participate in sports and are supported into re-employment, to achieve a meaningful life and a better quality of life.

Q. Why do SCI patients often suffer urinary tract infections?
A. Due to their injuries, SCI patients have neurogenic bladder, which means they have difficulties in controlling their bladder. Spinal doctors recommend their patients empty their bladder with self-intermittent or indwelling suprapubic catheters (catheters put into the top of the bladder). However, this could leave foreign material in the bladder, which may increase the risk of infections.

Q. There is a high incidence of antibiotic associated diarrhoea in these SCI patients, so are they particularly vulnerable?
A. Yes, because if they have diarrhoea, all their rehabilitation will be stopped. This not only affects the SCI patients, it also causes a lot of extra cost to the NHS. We have a very strong microbiology team, who have brought in strict rules about isolation, hand hygiene, etc.

The urinary infections were a major problem when I worked at Stoke Mandeville and the patients had many courses of antibiotics – we did not know about over prescribing and the resulting resistant bugs it produced. A daily dose of probiotics for patients in all hospitals must be a cheap and better alternative to treating repeated infections. If they are not provided, take your own!


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