Urinary tract infection in persons with spinal cord injury

Abstract

Persons with spinal cord injury (SCI) have an increased risk of developing urinary tract infections. Certain structural and physiological factors, such as bladder over-distention, vesicoureteral reflux, high-pressure voiding, large post-void residuals, stones in the urinary tract, and outlet obstruction increase the risk of infection. The method of bladder drainage also influences the risk of urinary tract infection, and most persons with SCI on indwelling or intermittent catheterization develop urinary tract infection. The association of behavioral and demographic factors with the risk of urinary tract infection are less well understood. The method of specimen collection must be considered when determining the significance of bacteria. A national consensus conference sponsored by the National Institute on Disability and Rehabilitation Research defined significant bacteriuria as: ≥ 10 2 colony forming units (cfu) of uropathogens per milliliter of urine in catheter specimens from persons on intermittent catheterization; ≥ 10 4cfu/mL in clean-voided specimens from catheter-free males using condom catheters; and any detectable concentration of uropathogens in indwelling catheter or suprapubic aspirate specimens. Symptomatic urinary tract infection warrants therapy, but the diagnosis is complicated by the poor sensitivity and specificity of symptoms and signs. Pyuria is generally present in persons with symptomatic urinary tract infection, although it is a nonspecific test, and its absence generally indicates the absence of symptomatic urinary tract infection. Treatment of asymptomatic bacteriuria has not been shown to be beneficial and increases the risk of development of antimicrobial-resistant uropathogens. Antibiotic prophylaxis is generally not recommended because of its unproven benefit in several studies and its association with emergence of antimicrobial resistance. A patient/physician partnership is important in planning the diagnostic evaluations, treatment, and long-term management of urinary tract infection in persons with SCI.