Retrospective study for risk factors for febrile UTI in spinal cord injury patients with routine concomitant intermittent catheterization in outpatient settings

Abstract

Study design: Retrospective study. Objectives: The objective of this study was to investigate the clinical risk factors for febrile urinary tract infection (UTI) in spinal cord injury-associated neurogenic bladder (NB) patients who perform routine clean intermittent catheterization (CIC). Setting: Rehabilitation Hospital, Kobe, Japan. Methods: Over a 3-year period, we retrospectively assessed the clinical risk factors for febrile UTI in 259 spinal cord injury patients diagnosed as NB and performing routine CIC with regard to the factors such as gender, the presence of pyuria and bacteriuria, and the categories of the American Spinal Injury Association (ASIA) impairment scale. Results: A total of 67 patients had febrile UTI in the follow-up period, with 57 cases of pyelonephritis, 11 cases of epididymitis and 2 cases of prostatitis, including the patients with plural infectious diseases. The causative bacteria were ranked as follows: Escherichia coli (74 cases), Pseudomonas aeruginosa (17 cases), Enterococcus faecalis (14 cases) and Klebsiella pneumoniae (12 cases). Antibiotic-resistant E. coli were seen, with 10.5% instances of extended-spectrum β-lactamase (ESBL) production and 23.8% of fluoroquinolone resistance. Multivariate analyses of clinical risk factors for febrile UTI showed that gender (male, P = 0.0431), and ASIA impairment scale C or more severe (P = 0.0266) were significantly associated with febrile UTI occurrence in NB patients with routine CIC. Conclusion: Our data demonstrated gender (male) and ASIA impairment scale C or more severe were significantly associated with febrile UTI occurrence in NB patients using routine CIC. Further prospective studies are necessary to define the full spectrum of possible risk factors for febrile UTI in these patients.

Results after implementation of a protocol on the incidence of urinary tract infection in an intensive care unit

“…In a retrospective study on the risk factors associated with urinary tract infection (UTI) based on a Clinical Practice Guideline , intermittent catheterization was strongly recommended as the first choice in patients with a need for catheterization; however for those patients who needed more than three intermittent catheterizations/day or patients with paraplegia who are at high risk of urinary tract dysfunction, the urethral catheterization became vital 9 .…”

Infección Urinaria en Pacientes con Lesión Medular

“…Esos hechos nos indican que el tratamiento para los pacientes con vejiga neurogénica, debe ser orientado de forma especial. [4][5][6][7] Patogénesis y Factores de Riesgo Patogénesis Se identificaron deficiencias en factores inmunes como el CD14 M y D88 cuando existe lesión medular, lo cual implica una alteración primaria en el sistema de reconocimiento de patógenos a la hora de controlar la infección. También en la respuesta pro y antiinflamatoria de la infección aguda.…”

Bladder irrigation with povidone‐iodine prevent recurrent urinary tract infections in neurogenic bladder patients on clean intermittent catheterization

“…4 Regarding UTI in NLUTD patients caused by spinal cord injury or dysfunction, symptomatic UTI reportedly occurs in 22%-45%. 5 Those patients often present without classic symptoms of UTIs but with abdominal or back pain, increased spasticity, and urinary incontinence. 6 Risk factors for UTIs among NLUTD patients are indwelling catheters, urinary stasis, high bladder pressure, and bladder stones.…”

“…Another study showed that the annual rate of symptomatic UTI was 26% for quadriplegic patients doing CIC 4 . Regarding UTI in NLUTD patients caused by spinal cord injury or dysfunction, symptomatic UTI reportedly occurs in 22%–45% 5 . Those patients often present without classic symptoms of UTIs but with abdominal or back pain, increased spasticity, and urinary incontinence 6 …”