A quantitative study of genital skin flora and urinary colonization in spinal cord injured patients

Abstract

This study was performed to define the relation between colonization of genital skin flora and bacteriuria in spinal cord injured patients with neurogenic bladder dysfunction. Twenty-seven female and 23 male spinal cord injured patients were included in the study. Patients were evaluated regarding their type of bladder management, educational status, level and degree of the spinal cord lesion. Quantitative cultures were obtained from the perineum labium/dorsum of penis, external meatus of urethra, and urine. We investigated whether the organisms isolated from urine were also present in one or more skin sites in every patient. In total 54 identical bacterial isolates were observed both from urine and one or more skin sites in 43 of the patients. Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae, and Proteus stuartii were the most common bacterial isolates. The distribution of identical colonization of genital skin flora with urine were as follows: 30 in urethra, one in perineum, four in urethra and perineum, nine in urethra and labium/dorsum of penis, and 10 in both three skin sites. Identical colonization of both perineum and labium/dorsum of penis with urine were significantly higher in female patients than those of males (P = 0.037, P = 0.003, respectively). No significant difference was found in the presence/distribution of colonization with respect to type of bladder management, educational status, and neurologic status. These results demonstrate the importance of the urethra, perineum, and labium/dorsum of penis as a source of bacteria causing urinary infection in spinal cord injured patients.

Significant upregulation of antimicrobial peptides and proteins in lichen sclerosus

“…As LS is often associated with significant skin barrier disruption and Gram‐negative bacteria such as E. coli frequently colonize the skin of the genital region, 1,2,39 the upregulation of hBD‐2 and psoriasin observed in patients with LS in the present study may indicate an innate host defence response caused by increased risk of local infection. In future studies, however, AMP expression profiles should be investigated in dependence on the actual bacterial colonization.…”

Epidemiology of Hospital-Acquired Infections in Veterans With Spinal Cord Injury and Disorder

“…Common organisms in urinary tract infections included enterococci, untyped gram-negative bacilli, and S. aureus. It is likely that the high incidence of staphylococcal urinary tract infection reflects the frequent use of urinary catheterization in persons with SCI&D. 27 Escherichia coli is often associated with urinary tract infection 25 ' 28,29 and accounted for 7.4% of isolates in this study. The most common pathogens in blood stream infections are S. aureus, coagulasenegative staphylococci, aerobic gram-negative bacilli, Candida species, and enterococci, 30 which was consistent with the findings of this study.…”

ESCMID guidelines for the management of the infection control measures to reduce transmission of multidrug-resistant Gram-negative bacteria in hospitalized patients

“…Acinetobacter calcoaceticus is the GNB most frequently found on normal skin, colonizing up to 25% of individuals ; other GNB are identified less commonly as part of the transient skin flora. Hospitalized patients, unlike healthy subjects, may have higher rates of skin colonization with Acinetobacter species and other GNB, especially in the perineal area .…”