Abstract
Study design:
Cross sectional study, including 38 outpatients. Standardized questionnaire was used and urine cultures were performed.
Objectives:
To study spinal cord-injured (SCI) patients bladder management, clinical aspects that symptomatic urinary tract infection (SUTI) may present and asymptomatic bacteriuria (AB) incidence with its antimicrobial susceptibility profile.
Setting:
Spinal cord injury outpatient rehabilitation clinic.
Results:
Clean intermittent catheterization is used by 71% of the patients. SUTI may have atypical clinical presentation (shivers, spasticity increase, headaches). In total, 65.7% (N=25) of the patients presented AB. Among these, the microorganisms isolated were resistant mainly to Ampicillin, Sulfamethoxazole–Trimethoprim and Norfloxacin, whose resistance rates were, respectively 73.3%, 60% and 33.3%.
Conclusion:
Special attention should be given to possible atypical symptoms for SUTI. Although a small amount of urine samples was analyzed, resistance rates against Ampicillin, Sulfamethoxazole–Trimethoprim, Ciprofloxacin and Nitrofurantoin appear to be higher among SCI patients compared to the general population, thus demonstrating the need for continuous monitoring of microorganisms susceptibility, in order to avoid therapeutic failure when dealing with this specific population.
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References
Romero-Cullerés G, Sanchez-Raya J, González-Viejo MA, Ramírez Garcerán L, García Fernández L, Conejero Sugrañes J . Quality of life evaluation in spinal cord injured patients comparing different management techniques. Actas Urol Esp 2010; 34: 537–542.
Singh R, Rohilla RK, Sangwan K, Siwach R, Magu NK, Sangwan SS . Bladder management methods and urological complications in spinal cord injury patients. Indian J Orthop 2011; 45: 141–147.
Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA, Healthcare Infection Control Practices Advisory Committee. Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol 2010; 31: 319–326.
Sahm DF, Thornsberry C, Mayfield DC, Jones ME, Karlowsky JA . Multidrug-resistant urinary tract isolates of Escherichia coli: prevalence and patient demographics in the United States in 2000. Antimicrob Agents Chemother 2001; 45: 1402–1406.
Zhanel GG, DeCorby M, Adam H . Prevalence of antimicrobial-resistant pathogens in Canadian hospitals: results of the Canadian Ward Surveillance Study (CANWARD 2008). Antimicrob Agents Chemother 2010; 54: 4684–4693.
van den Berg ME, Castellote JM, Mahillo-Fernadez I, de Pedro-Cuesta J . Incidence of spinal cord injury worldwide: a systematic review. Neuroepidemiology 2010; 34: 184–192.
Kirshblum SC, Burns SP, Biering-Sorensen F, Donovan W, Graves DE, Jha A et al International standards for neurological classification of spinal cord injury (Revised 2011). J Spinal Cord Med 2011; 34: 535–546.
Biering-Sorensen F, Craggs M, Kennelly M, Schick E, Wyndaele JJ . International lower urinary tract function basic spinal cord injury data set. Spinal Cord 2008; 46: 325–330.
Massa LM, Hoffman JM, Cardenas DD . Validity, accuracy, and predictive value of uti signs and symptoms in individuals with sci on intermittent catheterization. J Spinal Cord Med 2009; 32: 568–573.
Vaidyanathan S, Mansour P, Soni BM, Singh G, Sett P . The method of bladder drainage in spinal cord injury patients may influence the histological changes in the mucosa of neuropathic bladder—a hypothesis. BMC Urol 2002; 2: 5.
Esclarín De Ruz A, Garcia-Leoni E, Herruzo Cabrera R . Epidemiology and risk factors for urinary tract infection in patients with spinal cord injury. J Urol 2000; 164: 1285–1289.
Svensson E, Ertzgaard P, Forsum U . Bacteriuria in Spinal Cord Injured Patients With Neurogenic Bladder Dysfunction. Upsala J Med Sci 2004; 109: 25–32.
Trautner BW, Hull RA, Darouiche RO . Colicins prevent colonization of urinary catheters. J Antimicrob Chemother 2005; 56: 413–415.
Biering-Sorensen F, Bagi P, Hoiby N . Urinary tract infections in patients with spinal cord lesions: treatment and prevention. Drugs 2001; 61: 1275–1287.
Linsenmeyer TA, Bodner DR, Creasey GH, Green BG, Groah SL, Joseph A et al Bladder management for adults with spinal cord injury: a clinical practice guideline for health-care providers. J Spinal Cord Med 2006; 29: 527–573.
Mazzulli T . Resistance trends in urinary tract pathogens and impact on management. J Urol 2002; 168: 1720–1722.
Vaidyanathan S, Soni MB, Gurpreet S, Mansour P, Hughes PL, Oo T et al Protocol of a prospective cohort study of the effect of different methods of drainage of neuropathic bladder on occurrence of symptomatic urinary infection, and adverse events related to the urinary drainage system in spinal cord injury patients. BMC Urol 2001; 1: 2.
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We acknowledge the State of Sao Paulo Foundation for Research—FAPESP.
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Martins, C., Bronzatto, E., Neto, J. et al. Urinary tract infection analysis in a spinal cord injured population undergoing rehabilitation—how to treat?. Spinal Cord 51, 193–195 (2013). https://doi.org/10.1038/sc.2012.104
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DOI: https://doi.org/10.1038/sc.2012.104
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