Limited vs full microbiological investigation for the management of symptomatic polymicrobial urinary tract infection in adult spinal cord-injured patients

Darouiche, Rabih O.; Priebe, Michael M.; Clarridge, Jill E.

doi:10.1038/sj.sc.3100429

Cited by 10 publications

(11 citation statements)

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“…Polymicrobial growth in urine cultures from individuals with functionally normal urinary tracts is typically attributed to contaminated specimens, and urine culture is often repeated. However, detection of polymicrobial growth in urine cultures from SCI patients and urinary symptoms is highly likely to have clinical significance [ 16 ]. In this study, we analyzed urine culture tests that were conducted regardless of presence of symptoms in SCI patients, and polymicrobial bacteriuria was detected in 8.4% of cases.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of and Risk Factors for Multidrug-Resistant Bacteria in Urine Cultures of Spinal Cord Injury Patients

Kang

Lee

et al. 2015

Ann Rehabil Med

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ObjectiveTo identify the prevalence of multidrug-resistant (MDR) bacteria and identify their specific risk factors in routine urine specimens of spinal cord injury (SCI) patients.MethodsThis study was designed in a retrospective manner, reviewing the medical records of SCI patients who were admitted to a specialized SCI unit between January 2001 and December 2013. Patients were investigated for age, gender, American Spinal Injury Association impairment scale, SCI level, duration after injury, bladder management method, and hospitalization history within four weeks prior to visiting our unit. The results of routine urine cultures including presence of MDR organisms were analyzed.ResultsAmong the total 2,629 urine samples from the newly admitted SCI patients, significant bacteriuria was identified in 1,929 (73.4%), and MDR organisms were isolated in 29 (1.1%) cultures. There was an increasing trend of MDR organism prevalence from 2001 to 2013 (p<0.01). The isolation of MDR organisms in inpatients who were admitted for rehabilitation (1.3%) was significantly higher than it was among community-residing persons (0.2%) (p<0.05). By voiding method, patients who used a suprapubic indwelling catheter (3.3%) or a urethral indwelling catheter (2.6%) showed a higher rate of MDR organism isolation (p<0.05).ConclusionThere was an increasing trend of MDR organism isolation in SCI patients. Inpatients and persons who used indwelling catheters showed a higher risk of MDR organism isolation.

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Section: Discussionmentioning

confidence: 99%

Prevalence of and Risk Factors for Multidrug-Resistant Bacteria in Urine Cultures of Spinal Cord Injury Patients

Kang

Lee

et al. 2015

Ann Rehabil Med

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“…42 The catheter can be changed before the urine is collected for culture, in which case the microbiology laboratory will be spared workup of spurious species and the patient may be spared unnecessary antibiotics. 43 A small clinical trial found that changing the catheter before obtaining urine for culture and before starting antibiotic therapy was associated with a shorter time to afebrile status, improved clinical status, and a lower rate of symptomatic relapse. 44 The results of this trial make sense in terms of the pathogenesis of CAUTI, because the catheter-associated biofilm can seed the bladder again with the same organisms.…”

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confidence: 99%

Role of biofilm in catheter-associated urinary tract infection☆

Trautner

Darouiche

2004

American Journal of Infection Control

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354

263

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The predominant form of life for the majority of microorganisms in any hydrated biologic system is a cooperative community termed a "biofilm." A biofilm on an indwelling urinary catheter consists of adherent microorganisms, their extracellular products, and host components deposited on the catheter. The biofilm mode of life conveys a survival advantage to the microorganisms associated with it and, thus, biofilm on urinary catheters results in persistent infections that are resistant to antimicrobial therapy. Because chronic catheterization leads almost inevitably to bacteriuria, routine treatment of asymptomatic bacteriuria in persons who are catheterized is not recommended. When symptoms of a urinary tract infection develop in a person who is catheterized, changing the catheter before collecting urine improves the accuracy of urine culture results. Changing the catheter may also improve the response to antibiotic therapy by removing the biofilm that probably contains the infecting organisms and that can serve as a nidus for reinfection. Currently, no proven effective strategies exist for prevention of catheter-associated urinary tract infection in persons who are chronically catheterized.Health care providers have traditionally envisioned bacteria in their free-floating or planktonic state, and planktonic organisms have been the focus of traditional microbiologic methods of sampling and culture. 1 However, the predominant form of life for the majority of microorganisms in any hydrated biologic system, such as the human body, is a cooperative community termed a "biofilm." 2 A formal definition of biofilm includes 3 components: (1) adherence of the microorganisms, either to a surface or to each other; (2) a change in gene expression resulting in a different phenotype from the planktonic state; and (3) an extracellular matrix composed of host components and secreted bacterial products. 3,4 A functional definition of biofilm also includes the fact that biofilm results in chronic, persistent infections that are difficult to eradicate with antimicrobial therapy. 5 The relevance of biofilm to catheter-associated urinary tract infection (UTI) (CAU-TI) is that a foreign body, such as an indwelling urethral catheter, connecting a normally sterile, hydrated body site to the outside world will inevitably become colonized with microorganisms. 4 Thus, the central character in the story of CAUTI is really the biofilm on the urinary catheter. PATHOGENESIS OF URINARY CATHETER-ASSOCIATED BIOFILMThe pathogenesis of CAUTI is related to the susceptibility of inert catheter material to microbial colonization. On the surface of normal bladder mucosa, binding of bacteria triggers an NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript inflammatory response that results in an influx of neutrophils and sloughing of epithelial cells with bound bacteria. [6][7][8][9] Both processes contribute to clearance of the bacteria from the mucosal surface. In contrast, catheter surfaces have no inherent defense mechani...

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“…Polymicrobial cultures were also associated with MDRGNOs, independent of urine cultures, which are often polymicrobial. 8,33 Polymicrobial cultures have been shown to be a risk factor for inadequate antibiotic treatment, 15 which may provide an opportunity for GNOs to spread drug resistance. These findings highlight the need for continued and focused infection control.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Factors Associated With Multidrug-Resistant Gram-Negative Organisms in Patients With Spinal Cord Injury

Evans

Fitzpatrick

Jones

et al. 2017

Infect. Control Hosp. Epidemiol.

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OBJECTIVE Infections caused by multidrug-resistant gram-negative organisms (MDRGNOs) have been increasing every year. The objective of this study was to describe the prevalence of MDRGNOs and factors associated with MDRGNOs in patients with spinal cord injury or disorder (SCI/D). DESIGN Retrospective cohort study. METHODS Department of Veterans Affairs (VA) electronic health record data from 142 VA facilities were evaluated for 19,642 patients with SCI/D. Multivariable cluster-adjusted models were fit to identify factors associated with MDRGNO. RESULTS Gram-negative (GN) cultures occurred in 44% of patients with SCI/D receiving care at VA facilities, and 11,527 (41.3%) GN cultures had an MDRGNO. The most frequent GN organisms (GNOs) were Escherichia coli (28.5%), Klebsiella pneumoniae (17.0%), and Pseudomonas aeruginosa (16.0%). Two-thirds of GN cultures were from the outpatient setting, where MDRGNO prevalence was 37.6%. Significant geographic variation in the prevalence of MDRGNOs was identified (South, 44.7%; Northeast, 44.3%; West, 36.8%; Midwest, 34.4%). Other factors associated with an MDRGNO were older age, injury characteristics, comorbidities, specimen type, healthcare setting, and healthcare exposure. Black (odds ratio [OR], 1.58; 95% confidence interval [CI], 1.39-1.78) and Hispanic race (OR, 1.58; 95% CI, 1.28-1.95), polymicrobial culture (OR, 2.67; 95% CI, 2.46-2.90), and antibiotic use in the previous 90 days (OR, 1.62; 95% CI, 1.50-1.76) were also associated with having an MDRGNO. CONCLUSIONS MDRGNOs were common in community and healthcare settings among veterans with SCI/D, with significant geographic variation. Health care and antibiotic exposures were significant factors associated with MDRGNOs. Priority should be given to controlling the spread of MDRGNOs in this special population, including a focus on judicious use of antibiotics. Infect Control Hosp Epidemiol 2017;38:1464-1471.

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Limited vs full microbiological investigation for the management of symptomatic polymicrobial urinary tract infection in adult spinal cord-injured patients

Cited by 10 publications

References 10 publications

Prevalence of and Risk Factors for Multidrug-Resistant Bacteria in Urine Cultures of Spinal Cord Injury Patients

Prevalence of and Risk Factors for Multidrug-Resistant Bacteria in Urine Cultures of Spinal Cord Injury Patients

Role of biofilm in catheter-associated urinary tract infection☆

Prevalence and Factors Associated With Multidrug-Resistant Gram-Negative Organisms in Patients With Spinal Cord Injury

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