Urinary infections in patients with spinal cord injury

Abstract

Study design: A retrospective study concerning urinary tract infections in spinal cord injury (SCI) patients. Objectives: To check whether the regular (1/week) urine cultures allow a more accurate treatment of urinary tract infections in SCI patients compared to empiric treatment. Setting: Ghent University Hospital, East-Flanders, Belgium. Methods: Group 1: 24 tetraplegic patients; group 2: 22 paraplegic patients; group 3: 28 other polytrauma patients as controls. These groups were chosen as catheterisation and other voiding methods differ according to the underlying pathology.Results: An average of four clinically significant episodes of bacteriuria were found for groups 1 and 2, while group 3 experienced very few urinary infections. The mean species turnover of the first two groups was 2. No statistically significant difference was found in antibiotic-resistance patterns of organisms isolated. Conclusion: Despite different catheterisation techniques in para-and tetraplegic patients, we conclude that: (1) the number of episodes of clinical significant nosocomial urinary infections is not different; (2) the mean species turnover is the same; (3) because of the species turnover, the value of regular urine cultures for 'documented' treatment of clinical relevant urinary infections seems to be limited. So urine culture could be performed less frequently or only when therapy becomes mandatory; (4) No oral antibiotic with superior activity was found: treatment is best started empirically (after sampling for urine culture) and adjusted to the resulting antibiotic sensitivity screening.

Long-term follow-up study of outcomes of bladder management in spinal cord injury patients under the care of The Midlands Centre for Spinal Injuries in Oswestry

“…It is noteworthy that, UTI is the commonest reported of all complications of SCI in all series. 18,19 It is also worth mentioning that the series of W&D had a large proportion of sacral lesions, 47 out of 316 patients (15%), whereas in our group sacral lesions constituted only 1.7%. The density of the neurological deficit of W&D's series was not described.…”

Neurogenic bladder in patients with traumatic spinal cord injury: treatment and follow-up

“…5,6 No uniform definition of UTI was used in articles. 6,[14][15][16]18,23 In a long-term follow-up (ranged between 8 and 21 years, with a mean of 17.7 years) study evaluating the outcomes of bladder management in 119 SCI patients, 61% of the patients were reported to have complications. UTI stands out as the most common (80.1%) complication either alone (50%) or in combination with other complications.…”

“…[2][3][4] Urinary tract infection (UTI) is the most common complication in patients with SCI. 5,6 Problems related to UTIs are the most frequent reason for hospital readmissions, and symptoms such as autonomic dysreflexia and incontinence can cause serious physical disturbances or social inconvenience in the lives of those with SCI. 7 In order to reduce morbidity and to prevent urological complications, regular follow-up visits to a spinal cord rehabilitation clinic are required.…”

Clinical Data of Urine Culture and Antimicrobial Sensitivity Tests according to the Voiding Method over 15 Years in Patients with Spinal Cord Injury

“…In uncomplicated UTI, E. coli (34.4-67.0%) was the most common pathogen, as shown in many studies, followed by Enterococcus, P. aeruginosa, Enterobacter, Klebsiella species, and Staphylococcus [19][20][21]. On the contrary, urea splitting bacteria-i.e., P. aeruginosa, P. mirabilis, Enterococcus faecalis, Klebsiella species, Providencia species, and Morganella species-are more common in most studies of UTI in patients with SCI or indwelling catheter [22][23][24]. In our study, urea splitting organisms were isolated in 57.9% of cultures, and the two major organisms were P. aeruginosa and Klebsiella species.…”