Routine Urine Testing at the Spinal Cord Injury Annual Evaluation Leads to Unnecessary Antibiotic Use: A Pilot Study and Future Directions

Abstract

Two-thirds of the urine cultures of persons with SCI presenting for their annual examination were positive. Most of the positive cultures represented ASB cases, and more than a third of these were treated with antibiotics. A better understanding of the mandate for urine testing at the annual examination and the outcomes of this practice is an important first step in developing antibiotic stewardship for UTI in persons with SCI.

The ability of prior urinary cultures results to predict future culture results in neurogenic bladder patients

“…Finally, we studied urine culture results, not cultures specifically associated with urinary tract infections. Despite numerous guidelines to the contrary, the practise of obtaining urine culture results when there is no suspicion of an active infection is still very common, and concordance and resistance patterns in those with active infections may be more variable . However the fact that our results are quite similar to a prior study in the general population, who are less likely to be submitting urine cultures in the absence of symptoms, suggests this is less likely to change our results significantly …”

“…Educating patients on the importance of knowing their own “antibiogram” may help them avoid receiving suboptimal therapy. Most importantly, this information should continue to enforce the message that asymptomatic bacteriuria does not require treatment, and urine cultures should be restricted to situations in which the patient has symptoms or signs suggesting a high likelihood of a true urinary infection …”

“…Most importantly, this information should continue to enforce the message that asymptomatic bacteriuria does not require treatment, and urine cultures should be restricted to situations in which the patient has symptoms or signs suggesting a high likelihood of a true urinary infection. 16,17 The limitations of this research include a patient sample derived from a specific geographical region who required referral to a tertiary care facility. Generalizability will be enhanced with future studies assessing concordance in other geographic settings.…”

Conception and development of Urinary Tract Infection indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project

“…Second, due to comorbid neurologic impairments, traditional UTI symptoms are often not sensitive or specific enough; this has led to a long list of potential non-specific UTI symptoms such as increased spasticity, which are confusing for patients and non-SCI specialists to interpret in isolation. 31,32 Third, some of the most common symptoms that patients use in the community to determine if there is a UTI include foul-smelling or cloudy urine, both of which are common in the presence of asymptomatic bacteriuria, and in the absence of clinically relevant signs or symptoms, these individuals should not receive antibiotic treatment. Finally, routine urine testing in the absence of signs and symptoms is commonly employed in general practice, leads to the overdiagnosis of UTI.…”

“…Finally, routine urine testing in the absence of signs and symptoms is commonly employed in general practice, leads to the overdiagnosis of UTI. 32 In the general population, UTI generally refers to symptomatic bacterial cystitis, which is a common condition that if treated without antibiotic therapy and has a low risk of progression to pyelonephritis. 33 In contract, after SCI/D, there is a high rate of pyelonephritis and a higher baseline risk of urosepsis 34 These facts are often a driver for over-treatment of patients in the outpatient setting with some combination of a positive urine dipstick, urine culture and/or symptoms.…”