Aim of the study
Urinary tract infection (UTI) is common in complex urology patients, and can result in repeated admission, progressive renal impairment, and loss of renal transplants. Prophylactic antibiotics are associated with colonisation with multi-resistant bacteria such as ESBL. D-mannose is a fruit extract that inhibits bacterial adhesion to the urinary tract. In an RCT this reduced the risk of recurrent UTI in women prone to recurrent cystitis. Can D-mannose reduce the risk of recurrent UTI in complex urology patients? Does it also reduce the risk of ESBL colonisation?
Service development project 00989 was approved, regarding the use of D-mannose prophylaxis in complex patients in a tertiary paediatric urology centre. In patients 12-16 years dose of 1g orally TDS for 3 days, then BD ongoing was prescribed, (halved for patients 6-12 years of age). Demographics, diagnoses, UTI date, culture, and pyuria were recorded before and after starting D-mannose. Paired data were compared as UTI/month pre and post starting D-mannose. Data given as median (interquartile range). Analysis was by Wilcoxon and Fisher exact test, P<0.05 taken as significant.
11 complex urology patients were recruited, median age 11 years (range 7-17 years). Data was collected for a mean 5.3 months before D-mannose; 5.4 months post starting D-mannose. UTI rate reduced from 0.55(0.44-0.79) to 0.26(0-0.38) UTIs/month, 53% reduction, P=0.0029. There were 6 ESBL isolates in 3 patients before D-mannose prophylaxis vs. 1 persisting ESBL isolate in 1 patient whilst on D-mannose. This was not significant, P=0.66.
D-mannose was well tolerated with only 1 child developing loose stool.
D-mannose is effective prophylaxis, reducing risk of recurrent UTIs by 53% in complex urology patients. This will reduce the need for long-term prophylactic antibiotics in these patients and may help reduce the risk of multi-resistant organism colonisation.