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PostPosted: Sat Mar 18, 2017 2:51 pm 
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PREVENTING URINARY TRACT INFECTIONS
AND CATHETER BLOCKAGES

BARRY SIMPSON


CONTENTS
Abstract
Summary of methods to prevent urinary tract infections and catheter blockages.
An overnight catheter blockage.
Blockages: causes and remedies - Nitrofurantoin and catheter repositioning; sedimentary and positional blockages.
Supporting methods to prevent catheter blockages.
Could the blockages have been stopped by something else or by chance? In my case it is extremely unlikely that cessation of blockages was not associated with taking Nitrofurantoin as a prophylactic.
Predicting future blockages.
Nitrofurantoin and catheter repositioning stopped my blockages but what started them? Three steps to identify the bacteria responsible if this had not been done at the time of blockage. Where did the bacteria come from?
For how many people might the methods described be effective? What you could try if Nitrofurantoin does not work for you or if it has undesirable side-effects?
How serious are urinary catheter blockages?
Attitudes towards catheter blockages
A few reflections; deficiencies in current practice.
ABSTRACT
Between January and July 2016 I had 23 catheter blockages. Even without testing the contents of my catheter, after a while it began to look as though most of them were associated with urinary tract infections: so if my infections could be stopped, so too would the blockages. I started using Nitrofurantoin to prevent rather than to cure infections on 24th July 2016. I have had no blockage since. I took 50mg each evening for 30 days; then I gradually reduced it, and from the beginning of 2017, partially replaced it with natural antibiotics.
My catheter blockages were being caused by urinary tract infections of Staphylococcus saprophyticus and E. coli; these caused the sediment which led to the blockages. Using Nitrofurantoin as a prophylactic has controlled the bacteria and so the production of sediment to levels below that needed to cause a blockage. Although originally intended to prevent catheter blockages, it is likely that the method can also be used to control UTIs in those who do not have blockages, or even a catheter.
I have had a few occasions when I have had a limited amount of overheating which might have been minor urinary tract infections. These were accompanied by sediment in my catheter. As well as loosening the sediment by manipulating and bending my catheter, I have treated these by taking 50mg Nitrofurantoin, or for very minor overheating, lemon tea and vinegar on food. It appears that they have allowed a reduction in the dose, but in the amounts I have been taking (1/2 lemon and 30ml. vinegar per day) they would probably not be sufficient alone.
I do not know for how many others it would be suitable. If others try these methods without success, it is likely to be because their blockage was caused by a different bacterium not on the Nitrofurantoin hit-list. In such a case, it would be advisable to request an analysis of the catheter contents at the time of the blockage and then use a different antibiotic to control it.
SUMMARY OF METHODS TO PREVENT URINARY TRACT INFECTIONS AND CATHETER BLOCKAGES
Since May 2013: catheter changed every 5 weeks to July 2013 in hospital, then every 12 weeks.
May 2013 to 15th January 2016: no blockage; Nitrofurantoin taken occasionally to cure urinary infections.
16/17th January 2016 to 23/24th July 2016: 23 blockages; Nitrofurantoin taken occasionally to cure urinary infections.
Since March 2016: weekly bladder wash-outs.

Since 24th July 2016: no blockage;
50mg Nitrofurantoin taken on these evenings to prevent infections and blockages:

2016 July 24-31, August 1-22, 24-26, 28, 29, 30; September 1, 2, 4, 7, 8, 10, 13,16, 18, 19, 22, 25; October 1, 5, 6, 7, 11, 14, 15, 17,20(100mg), 21, 22, 23, 25, 29, 31; November 4, 5, 7, 10, 13, 16, 19, 22, 24, 26, 28; December 1, 3, 5, 8, 11, 12, 17, 22, 31. TOTAL 84x50mg.

2017 January 8, 16, 18, 22; February 5, 13, 16, 20, 25; March 11,25; April 2, 8, 13, 22, 28; May 1, 12,19; June 3, 13, 18; July 2, 10, 23; August 14, 15; September 17, 18; October 11, 17; November 2, 14; December none; TOTAL 33x50mg.

2018 January 5, 22, 31; February 9, 15; March 2, 9, 10, 17; April 8, 9, 23, 29; May 12; June 11,16; July 1, 16, 29; August 2, 13, 17; September 3, 10; October 7, 8, 16(100mg), 17, 29; November 5; December 15, 26. TOTAL 33x50mg.

2019 January none; February 12, 18; March 1(100mg), 2; April 6, 13; May 24(100mg); June 17; July 28.

Catheter repositioning to prevent non-sedimentary blockages.

Since January 2017: rolling catheter between hands and consumption of natural antibiotics: lemon tea (half a lemon), 30ml. vinegar on food.

AN OVERNIGHT CATHETER BLOCKAGE
It's coming up to 1'o clock in the morning. I waken up sweating profusely. I'm getting tremendous shocks of spasms. I have an overwhelming urge to move my legs but I can't. I can't move: following a spinal injury in 2013, I have been paralysed from the shoulders down. I fumble round the bed to find the 'phone. Eventually I find it, despite very little movement or sensation in my hands, now clawed up like an animal's paws. With my knuckles and a protruding little finger, I 'phone for a nurse, desperately trying to hold the 'phone to my ear. Fortunately a kind and thoughtful nurse had previously given me their direct number so that I don't have to endure the 111 service. The spasms and sweating are becoming even more severe. By the time she arrives, which can be over two hours later, the bedsheets are wet with sweat. 'Sorry I took so long. I've had a lot of catheter blockages tonight'.
Another one: between the nights of 16/17th January and 23/24th July 2016 I had 23 like that, typically between about midnight and 1am - long enough for urine to build up if my catheter had actually become blocked immediately after going to bed.
BLOCKAGES: CAUSES AND REMEDIES - NITROFURANTOIN AND CATHETER REPOSITIONING
I had a suprapubic catheter installed in May 2013. I had no blockage for the first two years and eight months.
At least two-thirds, but not all of my blockages were accompanied by sediment in my catheter. The last two blockages both occurred on the night of 23/24th July 2016. My catheter was replaced after the first of these. The second blockage was described by the nurse as 'positional'. Attending an earlier blockage, a different nurse had suggested that a possible cause was the catheter intake pressing against my bladder wall. So there seemed to be at least two causes of the blockages: by sediment and by the position of the catheter.
Why were all my blockages shortly after changing positions from sitting in my wheelchair to lying flat in bed? That is a better question than is my answer to it. The positional blockages were likely to have been caused by my catheter coming up against my bladder wall or the intake becoming too low for drainage of urine by gravity. The sedimentary blockages might have resulted from the catheter moving to a lower part of my bladder where sediment had collected.
The penny drops
Late on the morning of 24th July 2016 I began sweating heavily and my spasms became more severe. Having had two blockages the previous night, I thought this might be another one: so I called for a district nurse. When she came, she assured me that there was no blockage and 'phoned for medical advice. I could hear her part of the conversation. As soon as her conversation had finished, she told me that I had a suspected septicemia and that she would 'phone for an ambulance for immediate admission to hospital. I was surprised because I had none of the symptoms such as chills, high temperature, fast breathing or high pulse rate; indeed, her telephone conversation had made no reference to any of these symptoms.
http://www.healthline.com/health/septicemia#overview1
The nurse left and the ambulance soon arrived. The two paramedics took the standard readings such as pulse, breathing and temperature: everything was normal. I declined the invitation to go to hospital and assured the paramedics that I would take some Nitrofurantoin: my urinary tract infection was soon cleared.
This was not the first time that symptoms of an infection followed a blockage: the bacteria causing the infections were also creating the sediment which caused most of the blockages: so using Nitrofurantoin to prevent infections (rather than to cure them) in my case, also prevented catheter blockages. From the evening of 24th July I started taking 50mg Nitrofurantoin each day at about 8pm. I have had no blockage since.
In these circumstances, I try to maintain an awareness of the symptoms of septicaemia, the infection, and sepsis, the body's inflammatory reaction to it and to be aware that urinary infections can develop into septicaemia and sepsis; and because I have a spinal injury, also autonomic dysreflexia:
http://www.webmd.com/hypertension-high- ... c-overview

What about the blockages not caused by sediment - the 'positional' blockages? To prevent these I simply gently pull my catheter forward each night immediately after going to bed to pull it away from my bladder wall. At the same time I also unstrap the catheter and leg bag from my leg and lay it flat on the bed to help gravity by ensuring that as much of my catheter as possible is at a lower level than the intake.
In the afternoon of 1st March 2019 I began sweating or no obvious reason other than a minor urinary tract infection. I took 50mg Nitrofurantoin late in the afternoon and a further 50mg about 8pm. The infection seemed to be cleared until about 4pm on the following day when some sweating returned. I took 50mg Nitrofurantoin at 7.30pm. The sweating became more severe. After repositioning my catheter about 9.30pm my sweating subsided: it appears that my sweating on 2nd March was a result of a constriction of my catheter, possibly by it pressing up against my bladder wall.

The Users' Information Leaflet says that the normal dose of Nitrofurantoin for preventing infections is 50mg or 100mg daily at night but does not say for how long. On the principle that it is best not to take more medication than necessary, after 30 days taking 50mg, I began tentatively to omit it on a few nights and risk the horror of a blockage. For about 3 months I took 50mg on 3-4 nights per week and then reduced it further to only nights when I had a considerable amount of sediment in my catheter or sweating which could warn of a urinary infection.
(From January to August 2013 I was in a specialist spinal injuries hospital. Overheating of patients, including me, was very common. The solution was to train a fan on the patient. I was never offered Nitrofurantoin for this or for diagnosed urinary infections which were treated with other antibiotics via drips.)

SUPPORTING METHODS TO PREVENT CATHETER BLOCKAGES
The district nurses started giving me weekly bladder wash-outs soon after my blockages started: so the first few nights I omitted Nitrofurantoin were wash-out days. Wash-outs probably reduced the number of blockages but did not eliminate them. Not long after I reduced Nitrofurantoin to less than every night, I did begin to get sediment in my catheter. This seems to have been kept in amounts insufficient to cause a blockage by carers rolling the catheter between their hands to disturb it and by consuming natural antibiotics, including adding vinegar to food and drinking lemon tea (not surprising - the bladder wash-out solution contains citric acid). To make lemon tea, I simply cut an unpeeled lemon in half, cut up the half into pieces or slices put in a cup and add hot water, topping up several times and squeezing the lemon with a spoon. Lemons can be used in many other ways too:
http://www.healthextremist.com/lemon-pe ... emon-peel/
There are many web sites which offer advice on preventing urinary tract infections without antibiotics on prescription, such as:
https://draxe.com/home-remedies-for-uti/
https://www.healthline.com/health/women ... ibiotics#6
Such sites have much in common with each other, which adds to the likelihood of them being useful. D-Mannose (a sugar contained in several fruits including cranberries, apples, oranges, peaches and pineapples) garlic, vitamin C, apple cider vinegar and cranberry juice are commonly recommended.
I will never know whether rolling my catheter and taking natural antibiotics would have been sufficient to stop the blockages without Nitrofurantoin. I started them in January 2017, six months after my blockages had been stopped. It does appear that they have allowed a reduction in the dose, but in the amounts I have been taking (1/2 lemon and 30ml. vinegar per day) they would probably not be sufficient alone. For example, on the evening of 9th February 2018 after consuming the usual amounts of lemon and vinegar, my catheter had a large amount of sediment in it: so I took 50mg. Nitrofurantoin: the following morning it was clear.

COULD THE BLOCKAGES HAVE BEEN STOPPED BY SOMETHING ELSE OR BY CHANCE?
Could something else have stopped my blockages immediately, completely and for such a long time? All I can say is that I am not aware of doing anything else on and immediately following 24th July that could be expected to stop blockages other than taking Nitrofurantoin and catheter repositioning.
Although I have had no blockage since the night of 23/24th July 2016, often I have sediment in my catheter. When this looks sufficiently severe to risk a blockage, I take 50mg Nitrofurantoin about 8pm. Within an hour or two, the sediment is reduced or has gone completely.
I had 23 blockages in a period of 190 days from 16th January to 24th July 2016, no blockage since (365 days up to 24th July 2017). The probability of Nitrofurantoin and catheter repositioning having had no effect can be calculated as the probability of 23 random occurrences in a period of 190+365 days all being in the first 190 days.
The probability of any one of them being in the first 190 days is 190/(190+365) = 0.3423;
considering any two of the blockages, the probability of both of them being in the first 190 days would be 0.3423 x 0.3423 and so on until .....
the probability of all 23 being in the first 190 days is 0.3423 multiplied by itself 22 times = 1.95595e-11 = 0.0000000000195595 which is a little less than 2 chances in a hundred thousand million (a hundred thousand million is the number that 0.0000000000195595 would have to be multiplied by to get 1.95595).
http://www.rapidtables.com/calc/math/Ex ... ulator.htm
The base is 0.3423 and the exponent is 23.
So the probability that Nitrofurantoin and catheter positioning were not associated with stopping blockages is 0.0000000000195595; therefore the probability that they have been associated with stopping blockages is 1 - 0.0000000000195595 = 0.9999999999804405 where absolute certainty equals 1.
The binomial distribution can also be used with the same result:

http://www.vassarstats.net/textbook/ch5apx.html

where N = 23, k = 23, p = 0.3423 and the answer is p(k out of N)

The multinomial distribution can be used too:

https://www.easycalculation.com/statist ... bution.php
where the number of outcomes is 2 (blockage on a day in first 190 days /blockage a day in following 365 days), the number of occurrences 23 and 0, p = 0.3423 and 1-0.3423 = 0.6577.
Similarly, after 3 years without a blockage, all the above probabilities could be re-calculated by substituting 190/(190+(3x365)) = 0.1479 for 0.3423: so the probability of there being no association between taking Nitrofurantoin and catheter positioning stopping my blockages becomes 8.1146e-20.
These calculations are based on cautious assumptions. The probability of there being no association between taking Nitrofurantoin and the absence of blockages is likely to be even smaller than the very small probability of 1.95595e-11. On about 10 of the 190-day period with blockages I took Nitrofurantoin to cure urinary infections. I had no blockage on these days. So there is a case for reducing the period to 180 days, or fewer if the effect of Nitrofurantoin lasted for more than one day, and adding 10 or more days to the blockage-free period. If the period were reduced to 180 days, the probability of all 23 blockages being in the first 180 days would become (180/(180+375)) multiplied by itself 22 times = 5.6465e-12.
There is no practical difference between using a period of 190 days, 180 days or fewer. In all cases the probability of all 23 blockages being in this period by chance is so small as to be negligible. This very small probability means that it is practically certain that Nitrofurantoin and catheter repositioning were associated with stopping my blockages; it is not the probability of having a blockage tonight; nor is it a prediction of when a blockage can be expected.
PREDICTING FUTURE BLOCKAGES

Prediction methods rely on making inferences from the past: so while the treatment is never followed by a blockage, the prediction will remain zero for any period into the future.

However, where treatment sometimes fails, any of several methods can be used to estimate when future failures will occur.

If I were to have a blockage, the negative binomial distribution, also known as the Pascal distribution, could be used to predict the probability of a further blockage on each of the days following.

http://stattrek.com/online-calculator/n ... omial.aspx

The number of trials is the number of days after the first blockage, the number of successes is the number of blockages to be predicted (1 if the next blockage is to be predicted, 2 if it is to be the blockage after that and so on), probability of success on a single trial would be 1 divided by the number of days between the start of my blockage-free period and the first blockage and the negative binomial probability is the probability of the chosen blockage (1st, 2nd or whatever was chosen) occurring on the chosen number of days after the first blockage.

A cumulative version, which can make some calculations less laborious, is available at:

http://calculator.vhex.net/post/calcula ... stribution

The geometric distribution is a particular case of the negative binomial distribution where the number of successes, in my case, blockages, is equal to 1: so if the timing of only the next blockage is to be estimated, it can be used instead of the negative binomial distribution.

http://www.calcul.com/show/calculator/g ... &k=6&p=0.5

Here, the number of successes is the number of days without a blockage before the next one occurs, the probability of success is as for the negative binomial distribution and the maximum number of trials is the number of days for which you require the probability to be calculated. This calculator can save time by using the probability mass function, which shows the probabilities of a blockage on the days leading up to the day chosen.

It is possible to predict the number of blockages within any specified period using the Poisson probability distribution:

http://stattrek.com/online-calculator/poisson.aspx.

For example, suppose we wish to predict the chance of 1 blockage in a period of 7 days, the Poisson random variable would be 1. The average rate of success is the average number of blockages which in the past have occurred in 7 days (number of blockages/number of days in observation period x 7). To predict the chance of 2 blockages in 28 days, the Poisson random variable would be 2 and the average rate of success would be the average number of blockages in 28 days. As long as there are no blockages on nights following taking Nitrofurantoin, the average number of blockages for any period is 0: so until there is a blockage, the prediction of future blockages for any period is zero.

The negative binomial distribution, the geometric distribution and the Poisson probability distribution rely on the events (blockages in this case) being independent - not connected to each other, even indirectly by a common cause - and randomly distributed. This is liable to introduce inaccuracies into the predictions if the connections are not taken into account. On the other hand, if predictions from these techniques do not fit observations, that will be evidence that there are connections between the events (blockages) and that there is likely to be a common cause.

It might seem inconsistent that the effectiveness of Nitrofurantoin and catheter repositioning was demonstrated by the lack of randomness in the distribution of the 23 blockages between the 190 days without the treatment and the 365 days with it, while the techniques for predicting future blockages rely on them being randomly distributed. Not necessarily so; the predictive techniques would be used only in the period when the treatment is taking place.


NITROFURANTOIN AND CATHETER REPOSITIONING STOPPED MY BLOCKAGES BUT WHAT STARTED THEM?
I do not have a good answer to this. I had my catheter for 2 years and 8 months before I had a blockage. This period included about a dozen urinary infections.
On the evening of 16th January 2016 I was overheating so I took 500mg Paracetamol. That was the first time I had taken any since my catheter was installed. A few hours later I had my first blockage. The coincidence looked too close to believe that the Paracetamol had not played a part. I took no more Paracetamol but continued to have blockages about a week or ten days apart. After a few of these I convinced myself that they had nothing to do with Paracetamol: on 16th January I had a urinary infection and should have taken Nitrofurantoin instead of Paracetamol. So I left this out of the earlier paper:
http://static.smallworldlabs.com/spinal ... ckages.doc
http://sci.rutgers.edu/forum/showthread ... -Blockages
Nevertheless, I have taken no more Paracetamol.

Even without an analysis of the contents of my catheter at the time of a blockage, it is possible, by using a filtering process and information from the Internet, to identify the most likely bacterial culprits for my blockages. This might be important in identifying what other antibiotics are likely to be effective in preventing blockages for those who have an adverse reaction to Nitrofurantoin.
The filtering process comprises three stages:
1 Against what bacteria is Nitrofurantoin effective?
Before the blockages started I had more than a dozen urinary infections, readily stopped by Nitrofurantoin.
Nitrofurantoin has been shown to be effective against the following bacteria:
Citrobacter species, Coagulase negative staphylococci, E. coli, Enterococcus faecalis, Klebsiella species, Staphylococcus aureus, Staphylococcus saprophyticus, Streptococcus agalactiae
Many or all strains of the following genera are resistant to Nitrofurantoin: Enterobacter, Klebsiella, Proteus, Pseudomonas
https://en.wikipedia.org/wiki/Nitrofurantoin

Obviously, whatever bacteria caused the pre-blockage infections did not create enough sediment to cause a blockage. These bacteria must be on the Nitrofurantoin hit list; so too must those that did cause blockages, but they were not necessarily the same ones or in the same concentrations as those that did not cause a blockage.


2 It has been established that most of my blockages were associated with urinary infections, so which of these bacteria cause urinary infections?

E. Coli and Proteus mirabilis are often the cause of urinary infections:

https://www.google.co.uk/?gws_rd=cr&ei= ... rs&spf=395

http://www.msdmanuals.com/professional/ ... tions-utis

'Escherichia coli or E. coli, is responsible for more than 85 percent of all UTIs, according to a 2012 report in the journal Emerging Infectious Diseases.
Several other common bacteria also cause UTIs, including Staphylococcus saprophyticus, Pseudomonas aeruginosa and Klebsiella pneumonia.'
http://www.everydayhealth.com/e-coli/gu ... infection/
Pseudomonas, Klebsiella and Proteus are on the list for which Nitrofurantoin is not likely to be effective: so that leaves us with E. Coli and Staphylococcus saprophyticus.

3 Which of these bacteria cause sediment which could block a catheter?
Cloudy urine, but not sediment, is mentioned as a consequence of E. coli.
http://www.everydayhealth.com/e-coli/gu ... infection/

Sediment is associated with Staphylococcus saprophyticus:

https://www.ncbi.nlm.nih.gov/pubmed/6377440


That leaves Staphylococcus saprophyticus and E. coli as the prime suspects. Although Staphylococcus saprophyticus is the better fit to the information I have been able to find, E. coli is a much more common cause of urinary infections. Without any analyses of the contents of my catheter at the times of infections with or without blockages, it is not possible to be sure.

Because Nitrofurantoin is effective against some of the bacteria which cause urinary infections and which also create sediment in urine, it should not come as a surprise that it prevents some blockages associated with urinary infections.

I can only guess how many of my blockages could have been avoided if taking a sample of the contents of catheters were standard practice when a blockage occurs.
There might have been other mechanisms starting the blockages: an increase in urine pH, a change in brand of catheter .....
Why did I get infections from time to time after installation of my suprapubic catheter in May 2013 but no blockages until January 2016? Without analysis of my catheter contents it is only possible to speculate on a possible explanation: until January 2016 my infections were caused by E.coli which did not cause sufficient sediment to cause blockages. Then in January 2016, Staphylococcus saprophyticus arrived and this caused the blockages.
This would also explain why it took so long to recognise the connection between infections and blockages (23 infections spread over a period of six months): some of the infections were caused by E. coli with little or no Staphylococcus saprophyticus so there was no blockage; some of the blockages were caused by Staphylococcus saprophyticus with only subdued symptoms of infection.
Where did the bacteria come from?
Early in January 2019 the site where my suprapubic catheter enters into me healed more fully than I had ever noticed previously. Until then, there had always been a small amount of weeping around the site. I had no minor overheating as usually accompanies an infection after the weeping stopped until 12/2/19. My catheter was changed on 5/2/19, re-opening the wound and causing the weeping to resume. By mid March the catheter site had almost stopped weeping. Infections too had stopped: it is beginning to look as though my catheter entry point has been an entry point for the bacteria causing urinary tract infections. The next change of catheter, due on 30th April, was postponed. On 23rd May, my catheter was left with insufficient slackness. It pulled and began to leak around the site. I had a minor infection on 24th May. As the leakage around the catheter site had started, the reason for not changing my catheter had gone and it was changed on 27/5/19, a day short of 16 weeks after the previous change. It has not been changed since then. Since the third week in June, my catheter site has been healed. I have had no UTIs.
https://livingwithacatheter.com/forums/ ... edout=true

FOR HOW MANY PEOPLE MIGHT THE METHODS DESCRIBED BE EFFECTIVE?
What I have reported is, of course, my own story. I do not know for how many other people it might be effective but there seems to be a reasonable expectation that it might work for others - male or female - whose catheters are being blocked by sediment created by bacteria for which Nitrofurantoin is effective.

So it seems that blockages caused by bladder stones would not be prevented by Nitrofurantoin because the bacterium involved is Proteus mirabilis:
http://www.nature.com/sc/journal/v48/n1 ... 1032a.html

Nitrofurantoin will not be suitable for everyone. The Users' Information Leaflet lists many precautions and possible side effects.

It might aggravate some conditions, possibly including Parkinson's disease:
http://www.ehealthme.com/ds/nitrofurant ... ggravated/

Patients' reviews of the effectiveness and side-effects of Nitrofurantoin are mixed, for example

https://www.drugs.com/comments/nitrofurantoin/

https://healthunlocked.com/pmrgcauk/pos ... ofurantoin

One of the reasons that I set out in detail above the dosage I have been taking is that it is much lower than that usually recommended and does not follow the usual 'finish the course' advice to keep on taking it after the infection appears to have been cleared.

This became increasingly controversial following a study reported in the British Medical Journal in July 2017:

https://www.bmj.com/content/358/bmj.j3418

This was widely reported, including The Telegraph of 27th July 2017:

https://www.telegraph.co.uk/science/201 ... otics-say/

Not surprisingly, the study ruffled a few feathers among the professions involved:

https://www.nhs.uk/news/medication/ques ... tibiotics/
I have not had any side effects at the doses explained but others might. Nitrofurantoin was used to stop the bacterial blockages simply because it was the only antibiotic I had. If Nitrofurantoin does not stop your infections and blockages as it did for me, it might be because yours are being caused by a different bacterium from mine. A sample of the contents of your catheter at the time of a blockage would enable the bacterium responsible to be identified and an appropriate antibiotic might be chosen to use instead of Nitrofurantoin.
Some web sites suggesting other antibiotics for Staphylococcus saprophyticus, E. coli and other bacteria causing urinary tract infections are as follows:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC183755/
http://www.webmd.com/drugs/condition-23 ... ction.aspx

https://www.google.co.uk/?gws_rd=cr&ei= ... ns&spf=396

HOW SERIOUS ARE URINARY CATHETER BLOCKAGES?
Catheter blockages are at least distressing, especially if experienced help is not quickly available. Uncertainty about when help will arrive adds to the distress. I had to wait between about 40 minutes and 2 hours 15 minutes with the sweating and spasms progressively becoming more severe.
Is there likely to be any lasting or permanent damage? I am not aware of having any myself but serious kidney and bloodstream infections, septicaemia and autonomic dysreflexia have been experienced by others:
http://www.healthtalk.org/peoples-exper ... /blockages
How many deaths result from catheter blockages? We are not likely to get an accurate estimate because some of them are liable to be recorded as autonomic dysreflexia, sepsis or something else. Recorded deaths from sepsis are many and increasing:
https://www.nigms.nih.gov/education/pag ... epsis.aspx
http://www.world-sepsis-day.org/CONTENT ... eet_DE.pdf
It has been estimated that about 2,100 deaths per year result from the Foley catheter (but not all resulting from blockages?):
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4673556/
https://www.elsevier.com/connect/early- ... infections
About 450,000 people in the UK have permanent catheters and as many as a half of these experience 'recurrent infections with blockages and leakages':
http://www.healthtalk.org/files/nursing ... theter.pdf
The same paper quotes that 'In the UK, permanent catheters are used by 3% of people living in the community and 13% of care home residents'.


ATITUDES TOWARDS CATHETER BLOCKAGES

The nurses, particularly the night nurses, have left me with the impression that catheter blockages are much more common than they need to be. Often, they left me with a cheery 'See you again soon'. The prevailing attitude in both the medical and nursing professions that they are an inevitable consequence of having a catheter should be questioned.

In November 2016 I 'phoned the night nurses to thank them for coming to unblock my catheter on 23 nights between January and July, to explain why I have not called them out since July, and to offer to send them a copy of an earlier version of this paper: 'We don't give out e-mail addresses over the phone'. This was particularly disappointing because their own records of nursing call-outs will confirm the data on which this paper is based.

Meanwhile, patients wake in the early hours of the morning, sweating profusely, trembling with massive shocks of spasms, resulting in urine being forced back to the kidneys and in extreme cases, autonomic dysreflexia, internal damage and death. Night nurses rush between patients to unblock catheters which do not need to be blocked. Sometimes they have taken over 2 hours to reach me (although the average is about 1 hour 20 minutes).

A nurse from the local health authority once called to assess my condition. A friend who was with me mentioned my catheter blockages and offered her this paper: no thanks. 'It's something they can live with'.

During the course of preparing this paper I have had correspondence with many people connected to the medical or nursing professions. Although no-one else has used those exact words, 'something they can live with' sounds chillingly close to the attitude to so many of the responses (or lack of responses). Charities and other organisations that I have contacted appear to be content to work with the treatments and equipment that is available rather than to represent patients to get improvements.

Such has been the resistance to an approved dose of an approved medication. How much greater can we expect the difficulties of improvement in the medications available for spasms for example, or equipment such as catheters, when those needing them have been conditioned to expect nothing better than what they are given, when manufacturers are allowed to happily continue to sell the same old products. I must say I am left wondering whether the brick wall of complacency about catheter blockages also applies to other treatments and equipment that those with spinal injuries need - including treating the injury itself - and beyond spinal injuries.
http://www.dailymail.co.uk/health/artic ... aints.html
Surgeon who 'blew whistle' was posted a dead animal. The Times 25th August 2018 p7.
https://www.thetimes.co.uk/article/judg ... -wrlphv50h

A FEW REFLECTIONS

1 Catheter blockages are not something to accept as inevitable. Some of them are preventable.

2 Greater priority should be given to prevention in order to reduce the need for firefighting.

3 A small amount of resources devoted to preventing catheter blockages seems likely to result in a handsome pay-off in terms of savings in time spent unblocking catheters and unnecessary hospital appointments.

4 They are much more serious than is sometimes recognised among both the medical and nursing professions.

5 Prevention of catheter blockages has not had the priority it merits. Nurses could advise patients on preventing those caused by physical obstruction.

6 The method outlined worked for me but might not be so successful for some others. Nitrofurantoin can not be expected to prevent blockages caused by bladder stones for example, because it would not be effective against Proteus mirabilis, the bacterium involved.

7 Nitrofurantoin might have unacceptable side-effects for others as set out in the Users' Information Leaflet.

8 Samples of catheter contents should be taken when there is a blockage to identify what bacteria or other causes were responsible. This should lead to much earlier and more accurate diagnosis of the cause and what action to take. It can also be expected to reduce the suffering and damage to patients, waste of nursing time unblocking catheters which do not need to have been blocked and unnecessary hospital appointments resulting from wrongly guessing the causes of blockages in the absence of evidence. During this study three hospital consultants have been involved in guessing the cause of my blockages: bladder stones (2), kidney stones (1). All recommended that I should have hospital tests. Together with the locum who diagnosed emergency admission for suspected septicaemia, that makes four medical practitioners willing to guess a diagnosis in the absence of evidence, all of them wrong. I contacted one of them and sent him an earlier version of this paper: he showed no interest. The other three were surrounded by gatekeepers and means of preventing patients making contact.

9 The methods which worked for me could be offered to others with catheter blockages if there is no reason to believe that Nitrofurantoin would be unsuitable for them, particularly if samples of catheter contents have been analysed and found to contain bacteria against which Nitrofurantoin is effective, such as Staphylococcus saprophyticus or E. coli.

10 Depending on the results of analysis of samples from catheters at the time of blockage, it would be worthwhile to investigate the possibilities of using other antibiotics for those for whom Nitrofurantoin has undesirable side-effects or whose catheters have been blocked by sediment created by bacteria not on the Nitrofurantoin hit-list.
11 Blocked catheters are at least traumatic, at worst they are killers, they are expensive in terms of nursing and other medical staff time and resources and occur on a scale which makes them one of the most common healthcare problems. Some of the papers quoted in the previous section make the often-heard call for better catheters, which would empty the bladder completely and so reduce infections and blockages. Sadly, it is no surprise to read this, but until they are available, there remains a need for preventing blockages in the catheters which we have.
12 At the end of July 2017, there was conflicting advice on whether patients should finish courses of antibiotics:
http://www.telegraph.co.uk/science/2017 ... otics-say/
So far I have not found any decrease in the effectiveness of Nitrofurantoin with continued use or with irregular dosage. This is closer to the new advice than the more traditional recommendations.
13 In the nursing profession and in medicine, there is a tendency to standardise rather than to use discretion. Some examples are to change catheters at a fixed interval, in my case 12 weeks; weekly bladder wash-outs rather than when there was evidence that these needed to be done. Taking Nitrofurantoin at the doses and intervals in this study goes against the conventional practices. Standardisation requires much less interpretation and judgement than discretion; it is more defendable if something goes wrong.
14 Some significant questions remain not fully answered:
Why did I get no catheter blockages between May 2013, when my catheter was installed, and January 2016? I had more than a dozen urinary tract infections during this period, some of them more serious than those between January and July 2016 which were associated with blockages. Were the bacteria causing the infections different before January 2016?
Why did all my blockages occur at approximately the same time of day, when going to bed?
15 Nitrofurantoin has succeeded in at least two ways which are not mentioned in the Users' Information Leaflet. As well as its use as a prophylactic to prevent catheter blockages, it has reduced spasticity by removing that accompanying urinary tract infections.
16 Could anything have been done better? It looks likely that the dosage of Nitrofurantoin could have been reduced earlier if I had started taking lemon tea and vinegar earlier than January 2017. It is possible that if I had taken larger amounts of lemon tea and vinegar before my infections and blockages started, they would have never started.

P.S. Still no blockage since the night of 23rd/24th July 2016.
1st August 2019


Last edited by Barry on Sat Aug 31, 2019 7:52 am, edited 8 times in total.

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 Post subject: Re: Catheter blockages
PostPosted: Sun Mar 19, 2017 11:27 am 
Glad the blockage has been stopped but no way am I reading all that. :D


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