Incidence of urinary tract infection following initiation of intermittent catheterization among patients with recent spinal cord injury in Germany and the Netherlands

Abstract

Objective: To assess incidence of urinary tract infection (UTI) among patients with recent spinal cord injury (SCI) who initiated intermittent catheterization (IC). Design: Retrospective chart review. Setting: Two European SCI rehabilitation centers. Participants: Seventy-three consecutive patients with recent SCI who initiated IC. Outcome measures: Incidence of UTI, using six different definitions, each based on microbiology ± symptomatology ± mention of UTI. Rates were expressed in terms of numbers of UTIs per 100 patientmonths (PMs). Attention was focused on first-noted UTI during the three-month follow-up, as assessed with each of the six definitions. Results: Fifty-eight percent of patients (n = 33) met ≥1 definitions for UTI during follow-up (rate: 31.5 UTIs per 100 PMs), ranging from 14% (5.3 per 100 PMs; definition requiring bacteriuria, pyuria, and presence of symptoms) to 45% (22.7 per 100 PMs; definition requiring "mention of UTI"). Ten cases were identified using the definition that required bacteriuria, pyuria, and symptoms, whereas definitions that required bacteriuria and either pyuria or symptoms resulted in the identification of 20-25 cases. Median time to UTI ranged from 42 days ("mention of UTI") to 81 days (definition requiring bacteriuria and ≥100 leukocytes/mm 3). Conclusion: Depending on definition, 14% to 45% of patients with recent SCI experience UTI within three months of initiating IC. Definitions requiring bacteriuria and either pyuria or symptoms consistently identified about twice as many cases as those that required all three conditions. Standardizing definitions may help improve detection, treatment, and prevention of UTI within this vulnerable population.

New Intermittent Urinary Micro-Hole Zone Catheter Shows Enhanced Performance in Emptying the Bladder: A Randomised, Controlled Crossover Study

“…The association between residual urine and the UTI risk has been thoroughly investigated, although most studies involve individuals who void without a catheter or involve mixed populations of both CIC users and non-users or with different medical histories [ 28 , 29 , 30 , 31 , 32 , 33 , 34 ]. Adding to the complexity, the definition of UTIs often varies across trials, rendering the task to assess and generalise the results within this area challenging [ 35 ].…”

Indwelling catheter vs intermittent catheterization: is there a difference in UTI susceptibility?

“…There are various reasons for this: foremost, there is no internationally accepted standardized definition for UTIs in patients with NLUTD or for patients performing IC [ 8 ], and relevant heterogeneity for both clinical and laboratory criteria exists [ 8 ], which hinders comparison. Berger et al [ 20 ] demonstrated that depending on the definition the rate of diagnosed UTIs in the same cohort is 14–45%. Our conservative approach and prudent use of antibiotic therapy, in line with a strict antibiotic stewardship program in our department, might have further contributed to a restrictive UTI diagnosis.…”

The effect of ideal urine culture time on urinary infections after flexible ureteroscopy: A match‐pair case‐control study

“…In the first postoperative week, 68 patients were re‐hospitalised because of UTI (group 1). Empirical treatment was initiated for patients that were hospitalised because of having at least two of these factors: presence of 10 5 colonies of bacteria in urine culture, pyuria, fever or symptomatology 4 . The temperature of higher than 38°C that persisted for 48 hours was described as fever 5 .…”