Urinary Tract Infections After Combat-related Genitourinary Trauma

Abstract

BackgroundGenitourinary (GU) trauma accounted for 5% of combat-related injuries sustained by U.S. military personnel during Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF). Incidence and risk factors for long-term infectious complications, including urinary tract infections (UTI), have not been described in this unique population.MethodsDemographics, injury patterns, initial and long-term medical care, urologic complications, and infectious complications involving the urinary tract for enrollees within the Trauma Infectious Disease Outcomes Study (TIDOS) were collected from Department of Defense (DOD) and Department of Veterans Affairs (VA) data sources. Statistical analyses were conducted to identify candidate predictors for UTIs after GU trauma.ResultsAmong the 530 TIDOS enrollees who entered VA care, 90 (17%) sustained GU trauma. Blast injury (93.3%), injury during dismounted operations (56.7%), and lower extremity amputation (56.7%) were common characteristics among those with GU trauma. Higher median injury severity scores (ISS) were associated with GU trauma vs. non-GU trauma [33 (IQR: 21–38) vs. 17 (IQR: 9–26), P < 0.001]. Of those with GU trauma, 21 (23.3%) had ≥1 UTI (range 1–9) during DOD-VA care. A total of 42 unique UTI episodes were identified, with 11 (26.2%) occurring during initial DOD care, 19 (45.2%) during subsequent DOD care after initial hospital discharge, and 12 (28.6%) during VA care. The median time to first UTI episode was 49 days (IQR: 40.5–171.8). Having an UTI was associated with bladder (P = 0.002) and posterior urethral injury (P = 0.002), pelvic fracture (P < 0.001), urinary catheterization (P = 0.001), and urologic complications, including urinary retention or incontinence (P = 0.001) and stricture (P = 0.007). Pseudomonas aeruginosa (61.5%) was commonly isolated in urine cultures obtained within 6 months of the initial injury.ConclusionUTIs are a common infectious complication after combat genitourinary trauma, particularly in the setting of severe injury and urologic sequelae. Episodes of UTIs typically occur early on after the initial injury while in DOD care; however, recurrent infections may continue well into long-term VA care.Disclosures All authors: No reported disclosures.