Abstract
Study design
The Neurogenic Bladder Research Group (NBRG) registry is a multicenter prospective observational study. This manuscript is retrospective based on a cross-sectional survey.
Objectives
To assess patient subjective assessment of urinary tract infection (UTI) frequency and severity are associated with the degree of use of catheters or incontinence products.
Setting
Multiple hospitals across the United States.
Methods
Eligibility included: age > 18 years and acquired SCI. Over 1.5 years, 1479 eligible participants were enrolled. We excluded those with surgical reconstruction or diversion of the bladder. In total, 1282 participants were grouped by bladder management: (1) indwelling catheter (IDC), (2) clean intermittent catheterization (CIC), (3) external devices (pads/condom), and (4) volitional voiding (Void). UTI frequency was classified as 0, 1–3, 4–6, or > 6 over the prior year. UTI severity was determined by hospitalization for UTI in the prior year. Multivariate regression compared these factors across groups.
Results
UTIs were least frequent in Void followed by pads/condom, CIC, and IDC (all p ≤ 0.001). UTI severity followed a similar pattern. Controlling for covariates, the adjusted odds of UTI frequency (Void = reference) were 2.28 (1.38–3.76) for pads/condom, 3.42 (2.25–5.18) for CIC, and 4.3 (2.59–6.70) for IDC (all p ≤ 0.001).
Conclusions
Patient subjective assessment of UTI frequency is highest with IDC, followed by CIC, pads/condom, and lowest with spontaneous voiding. The odds of hospitalization for UTI were three times higher for IDC than spontaneous voiding. UTI risk should be considered when counseling patients about bladder management options. These associations do not imply causation but warrant further investigation in a prospective manner.
Sponsorship
Patient-Centered Outcomes Research Institute (PCORI) Award (CER14092138).
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Data archiving
The data sets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.
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JDR was responsible for the interpretation of results and manuscript writing. JJP was responsible for data analysis and manuscript revision. JTS, SML, JBM, BW and SPE aided in study design, acquired data, and revised the manuscript. All authors approved the final version of the manuscript.
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Roth, J.D., Pariser, J.J., Stoffel, J.T. et al. Patient subjective assessment of urinary tract infection frequency and severity is associated with bladder management method in spinal cord injury. Spinal Cord 57, 700–707 (2019). https://doi.org/10.1038/s41393-019-0268-2
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DOI: https://doi.org/10.1038/s41393-019-0268-2
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