Infections urinaires nosocomiales en médecine physique et réadaptation : particularités des vessies neurologiques

Abstract

Nosocomial urinary tract infection (NUTI) is a major matter of concern in Rehabilitation. The prevalence of NUTIs in Rehabilitation units seems similar to that of other medical units, but theses NUTIs are specific because they usually occur in patients presenting a neurologic bladder, who are particularly exposed to functional and urologic complications of the urinary tract. The criteria of bacteriuria and infection are different in patients with a neurogenic bladder than in the general population, and seem to be closely related with the type of management. Indwelling catheterization is associated with more frequent infections than self-catheterization, suprapubic catheter, condom, and voluntary voiding. The UTI mortality and morbidity have declined in recent decades thanks to a better knowledge of pathogenic factors and improved management of patients with a neurogenic bladder, leading to a reduced use of indwelling catheterization. Antibiotic prophylaxis is not associated with a reduced number of symptomatic infections and results in the increase of antibiotic-resistant bacteria. Antibiotic prophylaxis should not be systematically used in patients affected by a neurogenic bladder. There is little evidence to support the use of antiseptic or acidifying urine to prevent infections. The interest of cranberry juice remains to be assessed. There is presently no consensus of the use of antibiotics to treat UTIs, in terms of type, duration, and way of administration.