Urinary Tract Infections in Patients with Spinal Cord Injuries

D’Hondt, Frederiek; Everaert, Karel

doi:10.1007/s11908-011-0208-6

Cited by 56 publications

(48 citation statements)

References 50 publications

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“…High bladder pressure is a risk factor for renal failure and symptomatic UTI. 3,13 It promotes vesicoureteral reflux and ischemic injury to the bladder walls, creating favorable conditions for infection. 5 It is speculated that detrusor BoNTA injection induced inhibition of detrusor overactivity and decrease of detrusor pressure were responsible for the decrease of symptomatic UTI.…”

Section: Resultsmentioning

confidence: 99%

“…[1][2][3] Neurogenic detrusor overactivity (NDO), elevated intravesical pressure, reflux, elevated post void residuals, commonly found in SCI population, increase the risk of UTI. 4,5 Detrusor botulinum toxin A (BoNTA) injection is an effective method to treat NDO and decrease detrusor pressure, [6][7][8][9] but whether this method can suppress UTI is still in dispute and there was rare report.…”

Section: Introductionmentioning

confidence: 99%

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Detrusor botulinum toxin A injection significantly decreased urinary tract infection in patients with traumatic spinal cord injury

Chen

et al. 2013

Spinal Cord

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Study design: The study was designed as a single-arm clinical trial. Objectives: To investigate the effect of detrusor botulinum toxin A (BoNTA) injection on urinary tract infection (UTI) in patients with spinal cord injury (SCI). Setting: The study was performed in a national rehabilitation research center of China. Methods: Between September 2010 and May 2012, 41 male inpatients with neurogenic detrusor overactivity (NDO) caused by traumatic SCI, mean age 36.0 ± 8.8 years, duration of SCI since inclusion 21.5 ± 17.3 months, received an injection of 300 U BoNTA into detrusor. Before and 3 months after injection, each patient kept a bladder diary, underwent video-urodynamic investigation and urine culture. All UTIs occurring in the 6 months before and the 6 months after injection were recorded. Results: Before injection, the mean number of UTI over 6 months was 1.39 ± 1.36. After injection, the mean significantly decreased to 0.78 ± 0.96 (P ¼ 0.023). The mean maximum detrusor pressure during filling decreased significantly in the patients of detrusor overactivity (n ¼ 24) compared with patients of normo-active detrusor (n ¼ 17) after injection (35.4±12.2 vs 20.9±7.9 cmH 2 O, P ¼ 0.000), meantime, the decrease of UTI was significant in the former (1.29±1.21 vs 0.41±0.62 cmH 2 O, P ¼ 0.015) while no significant in the latter (1.46 ± 1.47 vs 1.04 ± 1.08, P ¼ 0.319). Conclusion: Detrusor BoNTA injection significantly decreased UTI in SCI patients with NDO. This effect seems to be related to the decrease of detrusor pressure.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Detrusor botulinum toxin A injection significantly decreased urinary tract infection in patients with traumatic spinal cord injury

Chen

et al. 2013

Spinal Cord

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“…Urinary tract infection was found to occur in high rates in traumatic SCI. In another study, a frequency of 52.6% and 67.1% urinary tract infection has been reported in NT and traumatic SCI patients, respectively (14). New et al evaluated the complications of rehabilitation patients only in the non-traumatic SCI patients and found that urinary tract infection was the most common complication (45.7%) (14,15).…”

Section: Discussionmentioning

confidence: 99%

Secondary complications and associated injuries in traumatic and non-traumatic spinal cord injury patients

Milicevic¹,

Bukumiric²,

Karadzov-Nikolic³

et al. 2012

Ser J Exp Clin Res

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“…Another factor in CAUTI is permanent low pressure voiding with permanent indwelling catheters or clean intermittent catheterization. 2 Regarding causative bacteria for CAUTI in spinal injury patients, Escherichia coli was the most common isolated pathogen (50%), followed by Pseudomonas aeruginosa (17.3%) and Enterococcus faecalis (7.7%). Recent antibiotic-resistant strains in UTI include multidrug resistant P. aeruginosa (MDRP), which is resistant to aminoglycosides, fluoroquinolones and beta-lactams.…”

Section: Introductionmentioning

confidence: 99%

Emergence and prevention measures for multidrug resistant Pseudomonas aeruginosa in catheter-associated urinary tract infection in spinal cord injury patients

et al. 2014

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Objective: To evaluate measures for preventing multidrug resistant Pseudomonas aeruginosa (MDRP) in catheter-associated urinary tract infection (CAUTI) in spinal cord injury patients. Setting: Spinal Cord Injury Unit of Hyogo Prefectural Hyogo Prefectural Rehabilitation Center, Kobe, Japan. Methods: We defined MDRP as resistance to amikacin, imipenem and levofloxacin. We had eight cases of MDRP-causing CAUTI in hospitalized neurogenic bladder patients caused by spinal cord injury in 2 months. Pulse-field gel electrophoresis (PFGE) was performed for epidemiological studies. We assessed prevention measures against MDRP emergence from the 2nd month, such as surveillance of CAUTI and infection control, and evaluated the outcomes of these measures over a total of 8 months. Results: Our PFGE results showed that these eight MDRP isolates could be considered as closely related strains. We concluded that this was an MDRP outbreak that was causing CAUTI. The isolated ratio of MDRP began to decrease over 4 months of surveillance and significantly decreased in the 4th quarter (7th and 8th months) compared with the 1st quarter (1st and 2nd months) (P ¼ 0.021) even though urinary tract device usage significantly increased over the same period (Po0.001). Conclusion:We experienced an outbreak of emergent MDRP causing CAUTI in neurogenic bladder patients with spinal cord injury. Our preventive measures for isolating the outbreak, including surveillance, may have led to the decrease we observed in the ratio of MDRP isolated. Spinal Cord (2015) 53, 70-74; doi:10.1038/sc.2014.154; published online 2 September 2014 INTRODUCTION Catheter-associated urinary tract infection (CAUTI) can have additional complications compared with other urinary tract infection (UTI) due to catheter occlusion and different kinds of causative bacteria. Urinary catheterization is the commonest cause of healthcare facility-acquired infections and complications from CAUTI are a major source of morbidity for spinal injury patients. 1 UTIs in spinal injury patients have several unique features such as complicated diagnosis due to a lack of symptoms. Another factor in CAUTI is permanent low pressure voiding with permanent indwelling catheters or clean intermittent catheterization. 2 Regarding causative bacteria for CAUTI in spinal injury patients, Escherichia coli was the most common isolated pathogen (50%), followed by Pseudomonas aeruginosa (17.3%) and Enterococcus faecalis (7.7%). Recent antibiotic-resistant strains in UTI include multidrug resistant P. aeruginosa (MDRP), which is resistant to aminoglycosides, fluoroquinolones and beta-lactams. 3 This study reports an outbreak of MDRP in neurogenic bladder CAUTI patients with spinal cord injury. We investigated the epidemiological aspects using pulse-field gel electrophoresis (PFGE), and then assessed our measures for preventing MDRP, including how surveillance affected the MDRP-positive ratio.

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Urinary Tract Infections in Patients with Spinal Cord Injuries

Cited by 56 publications

References 50 publications

Detrusor botulinum toxin A injection significantly decreased urinary tract infection in patients with traumatic spinal cord injury

Detrusor botulinum toxin A injection significantly decreased urinary tract infection in patients with traumatic spinal cord injury

Secondary complications and associated injuries in traumatic and non-traumatic spinal cord injury patients

Emergence and prevention measures for multidrug resistant Pseudomonas aeruginosa in catheter-associated urinary tract infection in spinal cord injury patients

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