1
|
Bigford GE, Garshick E. Systemic inflammation after spinal cord injury: A review of biological evidence, related health risks, and potential therapies. Curr Opin Pharmacol 2022; 67:102303. [PMID: 36206621 PMCID: PMC9929918 DOI: 10.1016/j.coph.2022.102303] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 01/25/2023]
Abstract
Individuals with chronic traumatic spinal cord injury (SCI) develop progressive multi-system health problems that result in clinical illness and disability. Systemic inflammation is associated with many of the common medical complications and acquired diseases that accompany chronic SCI, suggesting that it contributes to a number of comorbid pathological conditions. However, many of the mechanisms that promote persistent systemic inflammation and its consequences remain ill-defined. This review describes the significant biological factors that contribute to systemic inflammation, major organ systems affected, health risks, and the potential treatment strategies. We aim to highlight the need for a better understanding of inflammatory processes, and to establish appropriate strategies to address inflammation in SCI.
Collapse
Affiliation(s)
- Gregory E Bigford
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Eric Garshick
- Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, VA Boston Healthcare System, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| |
Collapse
|
2
|
Tractenberg RE, Groah SL. Development and Assessment of SCI Model Systems Complicated UTI Consensus Guidelines: A Psychometrically Designed Mixed-Methods Protocol. Top Spinal Cord Inj Rehabil 2022; 28:1-11. [PMID: 36457357 PMCID: PMC9678219 DOI: 10.46292/sci22-00002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Complicated UTI (cUTI) is highly prevalent among people with spinal cord injury and disease (SCI/D), but neither consistent nor evidence-based guidelines exist. Objectives We propose a two-phase, mixed-methods study to develop consensus around diagnostic and decision-making criteria for cUTI among people with SCI/D and the clinicians who treat them. Methods In phase 1 (qualitative), we will engage Spinal Cord Injury Model Systems (SCIMS) clinicians in focus groups to refine existing cUTI-related decision making using three reliable and validated Urinary Symptom Questionnaires for Neurogenic Bladder (USQNBs; intermittent catheterization, indwelling catheterization, and voiding) as points of departure, and then we will conduct a Delphi survey to explore and achieve consensus on cUTI diagnostic criteria among a nationally representative sample of clinicians from physical medicine and rehabilitation, infectious disease, urology, primary care, and emergency medicine. We will develop training materials based on these new guidelines and will deploy the training to both clinicians and consumers nationally. In phase 2 (quantitative), we will assess clinicians' uptake and use of the guidelines, and the impact of the guidelines training on consumers' self-management habits, engagement with the health care system, and antibiotic use over the 12 months after training. Results The output of this study will be diagnostic guidelines for cUTI among people with neurogenic lower urinary tract dysfunction (NLUTD) due to SCI/D, with data on uptake (clinicians) and impact (patients). Conclusion This mixed-methods protocol integrates formal psychometric methods with large-scale evidence gathering to derive consensus around diagnostic guidelines for cUTI among people with NLUTD due to SCI/D and provides information on uptake (clinicians) and impact (patients).
Collapse
Affiliation(s)
- Rochelle E. Tractenberg
- Collaborative for Research on Outcomes and Metrics, Georgetown University Medical Center, Washington, DC
- Departments of Neurology, Rehabilitation Medicine, and Biostatistics, Bioinformatics & Biomathematics, Georgetown University Medical Center, Washington, DC
| | - Suzanne L. Groah
- MedStar National Rehabilitation Hospital, Washington, DC
- MedStar Georgetown University Hospital, Washington, DC
| |
Collapse
|
3
|
Sartori AM, Padilla-Fernández B, 't Hoen L, Blok BFM, Castro-Díaz DM, Del Popolo G, Musco S, Hamid R, Ecclestone H, Groen J, Karsenty G, Phé V, Kessler TM, Pannek J. Definitions of Urinary Tract Infection Used in Interventional Studies Involving Neurourological Patients-A Systematic Review. Eur Urol Focus 2022; 8:1386-1398. [PMID: 34404618 DOI: 10.1016/j.euf.2021.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/09/2021] [Accepted: 07/27/2021] [Indexed: 12/16/2022]
Abstract
CONTEXT Neurourological patients often encounter bacteriuria without any symptoms or may experience symptoms suspicious of urinary tract infections (UTIs). However, there is a lack of guidelines that unequivocally state the definition of UTIs in this specific patient group. OBJECTIVE To present all used definitions of UTIs in neurourological patients. EVIDENCE ACQUISITION This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Studies were identified by electronic search of Medline, Embase, Cochrane controlled trials databases, and clinicaltrial.gov without a time limitation (last search September 2020) and by screening of reference lists and reviews. The occurrences of the various UTI definitions were counted and the frequencies calculated. EVIDENCE SYNTHESIS After screening 7164 abstracts, we included 32 studies enrolling a total of 8488 patients with a neurourological disorder who took part in an interventional clinical study. UTI definitions were heterogeneous. The concordance to predefined definitions was low. CONCLUSIONS Interventional clinical studies rarely report specific definitions for UTIs, and both clinical and laboratory criteria used are heterogeneous. A generally accepted UTI definition for neurourological patients is urgently needed. PATIENT SUMMARY Patients suffering from neurological disorders often experience symptoms in their lower urinary tract that resemble urinary tract infections. Furthermore, they can have positive urine cultures without symptoms (the so-called asymptomatic bacteriuria). However, clinical studies rarely report specific definitions for urinary tract infections, and when it is done, they are heterogeneous. A generally accepted urinary tract infection definition for neurourological patients is urgently needed. TAKE HOME MESSAGE: Interventional clinical studies on neurourological patients rarely report specific definitions for urinary tract infections (UTIs), and both clinical and laboratory criteria used are heterogeneous. A generally accepted UTI definition for neurourological patients is urgently needed.
Collapse
Affiliation(s)
- Andrea M Sartori
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Bárbara Padilla-Fernández
- Department of Urology, Complejo Hospitalario Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain.
| | - Lisette 't Hoen
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Bertil F M Blok
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - David M Castro-Díaz
- Department of Urology, Complejo Hospitalario Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - Giulio Del Popolo
- Department of Neuro-urology, Careggi University Hospital, Florence, Italy
| | - Stefania Musco
- Department of Neuro-urology, Careggi University Hospital, Florence, Italy
| | - Rizwan Hamid
- Department of Neuro-urology, London Spinal Injuries Centre, Stanmore, UK
| | - Hazel Ecclestone
- Department of Neuro-urology, London Spinal Injuries Centre, Stanmore, UK
| | - Jan Groen
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Gilles Karsenty
- Department of Urology, Aix Marseille University, Marseille, France
| | - Veronique Phé
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Academic Hospital, Sorbonne University, Paris, France
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Jürgen Pannek
- Neuro-Urology, Swiss Paraplegic Center, Nottwil, Switzerland
| |
Collapse
|
4
|
Vasdev R, Schlessinger E, Nakib N. Abdominal Spasm Induced Urinary Incontinence in a Patient With Cerebral Palsy: The Diagnostic Utility of Urodynamics in Neurological Disorder Management. Cureus 2021; 13:e16524. [PMID: 34430134 PMCID: PMC8376424 DOI: 10.7759/cureus.16524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2021] [Indexed: 11/10/2022] Open
Abstract
The presentation of incontinence in a patient with complex neurological disorders can vary substantially and depend on the location and nature of neurological injuries. In this case report, a 53-year-old female with cerebral palsy presents with recurrent episodes of catheter discharge and incontinence due to presumed bladder spasms. However, urodynamics (UDS) study reveals the spasms to be abdominal in origin. This unique case illustrates the diagnostic utility of UDS and important considerations when evaluating patients with complex medical and neurological disorders.
Collapse
Affiliation(s)
- Ranveer Vasdev
- Urology, University of Minnesota Twin Cities, Minneapolis, USA
| | | | - Nissrine Nakib
- Urology, University of Minnesota Twin Cities, Minneapolis, USA
| |
Collapse
|
5
|
Dinh A, Davido B, Duran C, Bouchand F, Bernard L. Antibiotic prophylaxis approaches for urinary tract infections. THE LANCET. INFECTIOUS DISEASES 2019; 18:1065. [PMID: 30303098 DOI: 10.1016/s1473-3099(18)30501-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 08/06/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Aurélien Dinh
- Infectious Disease Unit, Raymond Poincaré University Hospital, Assistance Publique Hôpitaux de Paris, Versailles Saint-Quentin University, 92380 Garches, France.
| | - Benjamin Davido
- Infectious Disease Unit, Raymond Poincaré University Hospital, Assistance Publique Hôpitaux de Paris, Versailles Saint-Quentin University, 92380 Garches, France
| | - Clara Duran
- Infectious Disease Unit, Raymond Poincaré University Hospital, Assistance Publique Hôpitaux de Paris, Versailles Saint-Quentin University, 92380 Garches, France
| | - Frédérique Bouchand
- Pharmacy Department, Raymond Poincaré University Hospital, Assistance Publique Hôpitaux de Paris, Versailles Saint-Quentin University, 92380 Garches, France
| | - Louis Bernard
- Internal Medicine and Infectious Diseases Department, Bretonneau Hospital, University Hospital of Tours, Tours, France
| |
Collapse
|
6
|
Dinh A, Davido B, Duran C, Bouchand F, Gaillard JL, Even A, Denys P, Chartier-Kastler E, Bernard L. Urinary tract infections in patients with neurogenic bladder. Med Mal Infect 2019; 49:495-504. [PMID: 30885540 DOI: 10.1016/j.medmal.2019.02.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 09/04/2018] [Accepted: 02/21/2019] [Indexed: 01/24/2023]
Abstract
Urinary tract infections (UTIs) in patients with neurogenic bladder are a major public health issue due to their high incidence and major consequences. Despite their frequency and potential severity, their physiopathology and management are poorly known. We provide a narrative literature review on the epidemiology, physiopathology, diagnostic criteria, microbiology, antimicrobial management, and prevention. UTIs among patients with neurogenic bladder are associated with high morbidity and healthcare utilization. Risk factors for UTI among this population are: indwelling catheter, urinary stasis, high bladder pressure, and bladder stones. Their diagnosis is a major challenge as clinical signs are often non-specific and rare. A urinary sample should be analyzed in appropriate conditions before any antibiotic prescription. According to most guidelines, a bacterial threshold≥103CFU/ml associated with symptoms is acceptable to define UTI in patients with neurogenic bladder. The management of acute symptomatic UTI is not evidence-based. A management with a single agent and a short antibiotic treatment of 10 days or less seems effective. Antibiotic selection should be based on the patient's resistance patterns. Asymptomatic bacteriuria should not be treated to avoid the emergence of bacterial resistance. Regarding preventive measures, use of clean intermittent catheterization, intravesical botulinum toxin injection, and prevention using antibiotic cycling are effective. Bacterial interference is promising but randomized controlled trials are needed. Large ongoing cohorts and randomized controlled trials should soon provide more evidence-based data.
Collapse
Affiliation(s)
- A Dinh
- Service des maladies infectieuses et tropicales, hôpital R. Poincaré, hôpitaux universitaires Paris Île de France Ouest (HU-PIFO), AP-HP, UVSQ, 104, boulevard R.-Poincaré, 92380 Garches, France.
| | - B Davido
- Service des maladies infectieuses et tropicales, hôpital R. Poincaré, hôpitaux universitaires Paris Île de France Ouest (HU-PIFO), AP-HP, UVSQ, 104, boulevard R.-Poincaré, 92380 Garches, France
| | - C Duran
- Service des maladies infectieuses et tropicales, hôpital R. Poincaré, hôpitaux universitaires Paris Île de France Ouest (HU-PIFO), AP-HP, UVSQ, 104, boulevard R.-Poincaré, 92380 Garches, France
| | - F Bouchand
- Pharmacie, hôpital R.-Poincaré, hôpitaux universitaires Paris Île de France Ouest, AP-HP, UVSQ, 92380 Garches, France
| | - J-L Gaillard
- Laboratoire de microbiologie, hôpital R.-Poincaré, hôpitaux universitaires Paris Île de France Ouest, AP-HP, UVSQ, 92380 Garches, France
| | - A Even
- Service de neuro-urologie, hôpital R.-Poincaré, hôpitaux universitaires Paris Île de France Ouest, AP-HP, UVSQ, 92380 Garches, France
| | - P Denys
- Service de neuro-urologie, hôpital R.-Poincaré, hôpitaux universitaires Paris Île de France Ouest, AP-HP, UVSQ, 92380 Garches, France
| | - E Chartier-Kastler
- Service d'urologie, hôpital Pitié Salpêtrière, AP-HP, université Paris VI, 75013 Paris, France
| | - L Bernard
- Département des maladies infectieuses et tropicales, hôpital Bretonneau, université F.-Rabelais, 37000 Tours, France
| |
Collapse
|
7
|
Patient subjective assessment of urinary tract infection frequency and severity is associated with bladder management method in spinal cord injury. Spinal Cord 2019; 57:700-707. [PMID: 30872758 DOI: 10.1038/s41393-019-0268-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 02/14/2019] [Accepted: 02/15/2019] [Indexed: 11/08/2022]
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).
Collapse
|
8
|
Randomized trial of concentrated proanthocyanidins (PAC) for acute reduction of bacteriuria in male veterans with spinal cord injury utilizing clean intermittent catheterization. Spinal Cord Ser Cases 2018; 4:58. [PMID: 29977609 DOI: 10.1038/s41394-018-0087-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 05/12/2018] [Accepted: 05/13/2018] [Indexed: 01/30/2023] Open
Abstract
Study design This study was a double-blind, placebo-controlled trial of a concentrated PACs compound (36 mg/capsule), in veterans with SCI and neurogenic lower urinary tract dysfunction (NLUTD) requiring intermittent catheterization (IC) over a 15-day period. Objectives The objective of this study was to evaluate the acute effects of concentrated proanthocyanidins (PACs) in the cranberry supplement ellura® on bacteriuria, leukocyturia, and subjective urine quality in catheter-dependent veterans with SCI. Setting Spinal cord injury center (outpatient clinic and inpatient unit). Methods Participants with positive urine bacterial colonization (≥50 K CFU/ml) were randomized to once daily concentrated PACs or identical placebo and followed with daily (in-patients) or twice weekly (out-patients) urine cultures with colony forming units per milliliter (cfu/ml) range (bacteriuria), microscopic urine white blood cells per high-powered field (wbc/hpf) quantification (leukocyturia), and surveys assessing urine clarity, odor, color, sediment, and overall satisfaction. A repeated measure analysis of variance was used to compare treatment vs. control and evaluate serial trends. Results A total of 13 male participants (7 randomized to concentrated PACs, 6 to placebo) completed the trial. There was no significant decrease over the study period in colony forming units per milliliter (cfu/ml) or log(wbc/hpf) in the treatment vs. the control group. Patients receiving concentrated PACs rated the clarity, odor, color, sediment, and overall satisfaction of their urine as insignificantly improved compared to placebo. Conclusions Acutely, there was no reduction of bacteriuria and pyuria or improvement in subjective urine quality for SCI patients treated with daily concentrated PACs.
Collapse
|
9
|
Previnaire JG, Le Berre M, Hode E, Dacquet V, Bordji H, Denys P, Soler JM. A 5-day antibiotic course for treatment of intermittent catheter-associated urinary tract infection in patients with spinal cord injury. Spinal Cord Ser Cases 2017; 3:17017. [PMID: 28503324 PMCID: PMC5425963 DOI: 10.1038/scsandc.2017.17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 03/13/2017] [Accepted: 03/19/2017] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION This was a retrospective monocentric study conducted at Centre Calvé, France, with the objective of evaluating the effectiveness of a 5-day course of antibiotics for symptomatic (mild urinary tract infection, UTI) or asymptomatic (aBact) bacteriuria in patients with spinal cord injury on intermittent catheterization. CASE PRESENTATION This study was conducted from May 2013 to September 2016. Antibiotic selection always followed culture collection and analysis of antibiograms. Patients with febrile UTI (>38°5) or recent history of urolithiasis were excluded. DISCUSSION Fifty-seven patients underwent 111 5-day courses of antibiotics. The two main bacteria involved were Escherichia coli and Klebsiella Pneumoniae. Most commonly prescribed antibiotics were cephalosporins, cotrimoxazole, fluoroquinolones and nitrofurantoins. On day 4 of the antibiotic course, bacteria were eradicated in 99% of cases. Clinical cure occurred in all patients by day 5 (end of treatment). After treatment, recurrence of UTI occurred in 16% of patients at week 3, 38% at week 6 and 50% at week 9. This rate was not significantly different from patients initially treated for aBact (20%, 35% and 44%, respectively). The UTI-free period was significantly shorter after treatment for aBact (45.5 days) than after treatment for UTI (53.7 days). None of the following characteristics were found to be risk factors for UTI: level or severity of lesion, gender, voiding mode, use of anticholinergic drugs and time since lesion. Results of this study support the use of a short 5-day course of antibiotics to treat mild UTI in patients with spinal cord injury, and provide further evidence against treatment of aBact.
Collapse
Affiliation(s)
| | - Morgane Le Berre
- Spinal Department, Centre Calvé, Fondation Hopale, Berck-sur-Mer, France
| | - Elisabeth Hode
- Spinal Department, Centre Calvé, Fondation Hopale, Berck-sur-Mer, France
- Department of Urology, Centre Calot, Fondation Hopale, Berck-sur-Mer, France
| | - Vincent Dacquet
- Spinal Department, Centre Calvé, Fondation Hopale, Berck-sur-Mer, France
- Infectious Disease Unit, Centre Calot, Fondation Hopale, Berck-sur-Mer, France
| | - Hemanou Bordji
- Spinal Department, Centre Calvé, Fondation Hopale, Berck-sur-Mer, France
| | - Pierre Denys
- Hôpital Raymond Poincaré, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France
| | | |
Collapse
|
10
|
Validity of urine dipstick test to assess eradication of urinary tract infection in persons with spinal cord injury. Prog Urol 2017; 27:424-430. [PMID: 28479108 DOI: 10.1016/j.purol.2017.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 02/26/2017] [Accepted: 03/30/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To prospectively study the predictive value (PV) of urine nitrite (NIT) dipstick testing against urine cultures during antibiotic treatment for urinary tract infection (UTI), and other situations, in patients with spinal cord injury (SCI). METHODS Inpatients with SCI on intermittent catheterisation (IC) or a Foley indwelling catheter (FC) were included. Urine specimens were collected in patients without symptoms (routine), with symptoms of UTI (suspicion), and on day 4 of a 5-day antibiotic treatment (ATB+3). RESULTS A total of 157 urine samples were collected in 61 patients: 34 were on IC (95 samples) and 27 on FC (62 samples). The prevalence of asymptomatic bacteriuria in the urine cultures was 89% in routine (70 samples). At ATB+3, microbiological cure was found in 27/30 specimens (IC group) and 2/6 (FC group). In the routine condition, the specificity and positive PV of the NIT tests was 1.00 and sensitivity 0.63. The negative PV was low in both groups. In suspicion of UTI, the sensitivity was between 0.69 and 0.55, the positive PV was 1.00 and the negative PV 0.00 for both groups. At ATB+3, the negative PV and sensitivity was 1.00, specificity 0.85 and positive PV 0.43 in the IC group, and in the FC group, specificity was 1.00, negative PV 0.33 and sensitivity 0.00. CONCLUSION In the SCI population on intermittent or indwelling catheters with high prevalence of bacteriuria, dipstick testing helped assess the eradication of germs during antibiotic treatment, but showed no value in the decision making process for UTI. LEVEL OF EVIDENCE 3.
Collapse
|
11
|
Tofte N, Nielsen ACY, Trøstrup H, Andersen CB, Von Linstow M, Hansen B, Biering-Sørensen F, Høiby N, Moser C. Chronic urinary tract infections in patients with spinal cord lesions - biofilm infection with need for long-term antibiotic treatment. APMIS 2017; 125:385-391. [DOI: 10.1111/apm.12685] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 02/03/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Nete Tofte
- Department of Clinical Microbiology; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - Alex C. Y. Nielsen
- Department of Clinical Microbiology; Hvidovre Hospital; Copenhagen University Hospital; Copenhagen Denmark
| | - Hannah Trøstrup
- Department of Clinical Microbiology; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - Christine B. Andersen
- Department of Clinical Microbiology; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - Michael Von Linstow
- Clinic for Spinal Cord Injuries; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - Birgitte Hansen
- Clinic for Spinal Cord Injuries; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - Fin Biering-Sørensen
- Clinic for Spinal Cord Injuries; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - Niels Høiby
- Department of Clinical Microbiology; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - Claus Moser
- Department of Clinical Microbiology; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| |
Collapse
|
12
|
Duanngai K, Sirasaporn P, Ngaosinchai SS. The reliability and validity of using the urine dipstick test by patient self-assessment for urinary tract infection screening in spinal cord injury patients. J Family Med Prim Care 2017; 6:578-582. [PMID: 29417012 PMCID: PMC5787959 DOI: 10.4103/2249-4863.222024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aims: The aim of this is to evaluate the reliability of the urine dipstick test by patients’ self-assessment for urinary tract infection (UTI) screening and to determine the validity of urine dipstick test. Settings: Rehabilitation Department, Srinagarind Hospital, Thailand. Study Design: A diagnostic study. Subjects and Methods: This study compared the urine dipstick test (index test) with the National Institute on Disability and Rehabilitation Research (NIDRR) criteria (gold standard test) in spinal cord injury (SCI) patients. The urine dipstick test informed positive and negative results. Besides the NIDRR criteria classified as UTI and no UTI. The interrater reliability was measured in the sense of Kappa whereas the validity of urine dipstick test was reported in terms of sensitivity, specificity, positive likelihood ratio (LR) (+LR), negative LR (−LR), positive predictive value (PPV), and negative predictive value (NPV). Results: Out of the 56 participants, the kappa of urine dipstick test for leukocyte esterase, nitrite, and combined leukocyte esterase and nitrite were 0.09, 0.21, and 0.52, respectively. The nitrite urine dipstick test showed the highest sensitivity (90%). The combined leukocyte esterase and nitrite urine dipstick test gave the highest specificity (87%), PPV (60%), NPV (93%), and +LR (5.63). Conclusions: The interrater reliability of combined leukocyte esterase and nitrite urine dipstick test was moderate agreement. The combined leukocyte esterase and nitrite urine dipstick test showed high level of both sensitivity and specificity. The combined leukocyte esterase and nitrite urine dipstick test should be promoted for patients’ self-assessment for UTI screening in SCI patients.
Collapse
Affiliation(s)
- Krit Duanngai
- Department of Rehabilitation Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand
| | - Patpiya Sirasaporn
- Department of Rehabilitation Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand
| | | |
Collapse
|
13
|
Dinh A, Toumi A, Blanc C, Descatha A, Bouchand F, Salomon J, Hanslik T, Bernuz B, Denys P, Bernard L. Management of febrile urinary tract infection among spinal cord injured patients. BMC Infect Dis 2016; 16:156. [PMID: 27084753 PMCID: PMC4833936 DOI: 10.1186/s12879-016-1484-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 03/25/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Urinary tract infection (UTI) among patients with neurogenic bladder is a major problem but its management is not well known. We studied the relationship between antibiotic regimen use and the cure rate of those infections among 112 patients with neurogenic bladder. METHODS We studied a retrospective cohort of febrile UTI among patients with neurogenic bladder. Drug selection was left to the discretion of the treating physicians, in accordance with current guidelines. Patients were divided into 3 groups according to antibiotic treatment duration (<10 days, between 10 and 15 days, and >15 days). We analysed clinical and microbiogical cure rate one month after the end of antibiotic treatment. RESULTS The three groups of patients were similar, especially in terms of drug treatment (equal distribution). The cure rates were not significantly different (71.4 %, 54.2 %, and 57.1 %, respectively; p = 0.34). Moreover, there was no difference in cure rate between mono and dual therapy (44 % for monotherapy vs. 40 % for dual therapy; p = 0.71). CONCLUSION This descriptive study supports the efficacy of antimicrobial treatment duration of less than 10 days and the use of monotherapy to treat febrile UTI among patients with neurogenic bladder. A randomized control trial is required to confirm these data.
Collapse
Affiliation(s)
- Aurélien Dinh
- Infectious Disease Unit, Garches PIFO University Hospital, AP-HP, Versailles Saint Quentin University, Garches, France.
| | - Adnène Toumi
- Infectious Diseases Unit, University Hospital, Monastir, Tunisia
| | - Constance Blanc
- Infectious Disease Unit, Garches PIFO University Hospital, AP-HP, Versailles Saint Quentin University, Garches, France
| | - Alexis Descatha
- Infectious Disease Unit, Garches PIFO University Hospital, AP-HP, Versailles Saint Quentin University, Garches, France
| | - Frédérique Bouchand
- Pharmacy, University Hospital, AP-HP, Versailles Saint Quentin University, Garches, France
| | - Jérôme Salomon
- Infectious Disease Unit, Garches PIFO University Hospital, AP-HP, Versailles Saint Quentin University, Garches, France
| | - Thomas Hanslik
- Internal Medicine Unit, University Hospital, AP-HP, Versailles Saint Quentin University, Boulogne-Billancourt, France
| | - Benjamin Bernuz
- Physical Medicine and Rehabilitation Department, University Hospital, AP-HP, Versailles Saint Quentin University, Garches, France
| | - Pierre Denys
- Physical Medicine and Rehabilitation Department, University Hospital, AP-HP, Versailles Saint Quentin University, Garches, France
| | - Louis Bernard
- Infectious Disease Unit, Bretonneau University Hospital, Tours, France
| |
Collapse
|
14
|
Vigil HR, Hickling DR. Urinary tract infection in the neurogenic bladder. Transl Androl Urol 2016; 5:72-87. [PMID: 26904414 PMCID: PMC4739987 DOI: 10.3978/j.issn.2223-4683.2016.01.06] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 01/05/2016] [Indexed: 12/18/2022] Open
Abstract
There is a high incidence of urinary tract infection (UTI) in patients with neurogenic lower urinary tract function. This results in significant morbidity and health care utilization. Multiple well-established risk factors unique to a neurogenic bladder (NB) exist while others require ongoing investigation. It is important for care providers to have a good understanding of the different structural, physiological, immunological and catheter-related risk factors so that they may be modified when possible. Diagnosis remains complicated. Appropriate specimen collection is of paramount importance and a UTI cannot be diagnosed based on urinalysis or clinical presentation alone. A culture result with a bacterial concentration of ≥10(3) CFU/mL in combination with symptoms represents an acceptable definition for UTI diagnosis in NB patients. Cystoscopy, ultrasound and urodynamics should be utilized for the evaluation of recurrent infections in NB patients. An acute, symptomatic UTI should be treated with antibiotics for 5-14 days depending on the severity of the presentation. Antibiotic selection should be based on local and patient-based resistance patterns and the spectrum should be as narrow as possible if there are no concerns regarding urosepsis. Asymptomatic bacteriuria (AB) should not be treated because of rising resistance patterns and lack of clinical efficacy. The most important preventative measures include closed catheter drainage in patients with an indwelling catheter and the use of clean intermittent catheterization (CIC) over other methods of bladder management if possible. The use of hydrophilic or impregnated catheters is not recommended. Intravesical Botox, bacterial interference and sacral neuromodulation show significant promise for the prevention of UTIs in higher risk NB patients and future, multi-center, randomized controlled trials are required.
Collapse
Affiliation(s)
- Humberto R Vigil
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Duane R Hickling
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| |
Collapse
|
15
|
Cheung J, Rancourt A, Di Poce S, Levine A, Hoang J, Ismail F, Boulias C, Phadke CP. Patient-identified factors that influence spasticity in people with stroke and multiple sclerosis receiving botulinum toxin injection treatments. Physiother Can 2015; 67:157-66. [PMID: 25931667 DOI: 10.3138/ptc.2014-07] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe the nature, extent, and impact of spasticity; determine factors that are perceived to influence its severity; and examine the relationship between time since diagnosis and impact of spasticity on daily activities in people with stroke and multiple sclerosis (MS) who are receiving botulinum toxin injection treatments. METHODS After a cross-sectional telephone survey, descriptive statistics and correlations were analyzed separately for the stroke and MS groups. RESULTS A total of 29 people with stroke and 10 with MS were surveyed. Both groups perceived increased spasticity with outdoor cold (69% stroke, 60% MS), muscle fatigue (59% stroke, 80% MS), and mental stress (59% stroke, 90% MS). No statistically significant correlations were found between time since diagnosis and perceived impact of spasticity on function in the stroke (r=0.07, p=0.37) or MS (r=0.16, p=0.33) groups. The MS group experienced bilateral and more severe perception of spasticity in the legs than the stroke group and identified more factors as worsening their spasticity (p<0.05). Severity of leg (but not arm) spasticity was significantly correlated with severity of impact of the following factors in the MS group only: lying on the back (r=0.70, p<0.05), outdoor heat (r=0.61, p<0.05), and morning (r=0.59, p<0.05). CONCLUSION Intrinsic and extrinsic triggers can influence the perception of spasticity differently depending on individual factors, severity, location (arm vs. leg), and distribution of spasticity (unilateral vs. bilateral). Clinicians can use the findings to better understand, educate, and treat people with stroke and MS.
Collapse
Affiliation(s)
| | | | | | | | | | - Farooq Ismail
- Spasticity Research Program, West Park Healthcare Centre ; Division of Physiatry, University of Toronto
| | - Chris Boulias
- Spasticity Research Program, West Park Healthcare Centre ; Division of Physiatry, University of Toronto
| | - Chetan P Phadke
- Department of Physical Therapy ; Spasticity Research Program, West Park Healthcare Centre ; Faculty of Health, York University, Toronto
| |
Collapse
|
16
|
|
17
|
Kopp MA, Druschel C, Meisel C, Liebscher T, Prilipp E, Watzlawick R, Cinelli P, Niedeggen A, Schaser KD, Wanner GA, Curt A, Lindemann G, Nugaeva N, Fehlings MG, Vajkoczy P, Cabraja M, Dengler J, Ertel W, Ekkernkamp A, Martus P, Volk HD, Unterwalder N, Kölsch U, Brommer B, Hellmann RC, Saidy RRO, Laginha I, Prüss H, Failli V, Dirnagl U, Schwab JM. The SCIentinel study--prospective multicenter study to define the spinal cord injury-induced immune depression syndrome (SCI-IDS)--study protocol and interim feasibility data. BMC Neurol 2013; 13:168. [PMID: 24206943 PMCID: PMC3827331 DOI: 10.1186/1471-2377-13-168] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 10/31/2013] [Indexed: 02/06/2023] Open
Abstract
Background Infections are the leading cause of death in the acute phase following spinal cord injury and qualify as independent risk factor for poor neurological outcome (“disease modifying factor”). The enhanced susceptibility for infections is not stringently explained by the increased risk of aspiration in tetraplegic patients, neurogenic bladder dysfunction, or by high-dose methylprednisolone treatment. Experimental and clinical pilot data suggest that spinal cord injury disrupts the balanced interplay between the central nervous system and the immune system. The primary hypothesis is that the Spinal Cord Injury-induced Immune Depression Syndrome (SCI-IDS) is 'neurogenic’ including deactivation of adaptive and innate immunity with decreased HLA-DR expression on monocytes as a key surrogate parameter. Secondary hypotheses are that the Immune Depression Syndrome is i) injury level- and ii) severity-dependent, iii) triggers transient lymphopenia, and iv) causes qualitative functional leukocyte deficits, which may endure the post-acute phase after spinal cord injury. Methods/Design SCIentinel is a prospective, international, multicenter study aiming to recruit about 118 patients with acute spinal cord injury or control patients with acute vertebral fracture without neurological deficits scheduled for spinal surgery. The assessment points are: i) <31 hours, ii) 31–55 hours, iii) 7 days, iv) 14 days, and v) 10 weeks post-trauma. Assessment includes infections, concomitant injury, medication and neurological classification using American Spinal Injury Association impairment scale (AIS) and neurological level. Laboratory analyses comprise haematological profiling, immunophenotyping, including HLA-DR expression on monocytes, cytokines and gene expression of immune modulators. We provide an administrative interim analysis of the recruitment schedule of the trial. Discussion The objectives are to characterize the dysfunction of the innate and adaptive immune system after spinal cord injury and to explore its proposed 'neurogenic’ origin by analyzing its correlation with lesion height and severity. The trial protocol considers difficulties of enrolment in an acute setting, and loss to follow up. The administrative interim analysis confirmed the feasibility of the protocol. Better understanding of the SCI-IDS is crucial to reduce co-morbidities and thereby to attenuate the impact of disease modifying factors to protect neurological “outcome at risk”. This putatively results in improved spinal cord injury medical care. Trial registration DRKS-ID: DRKS00000122 (German Clinical Trials Registry)
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jan M Schwab
- Department of Neurology and Experimental Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
| |
Collapse
|
18
|
El Habnouni S, Lavigne JP, Darcos V, Porsio B, Garric X, Coudane J, Nottelet B. Toward potent antibiofilm degradable medical devices: a generic method for the antibacterial surface modification of polylactide. Acta Biomater 2013; 9:7709-18. [PMID: 23603533 DOI: 10.1016/j.actbio.2013.04.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 04/03/2013] [Accepted: 04/09/2013] [Indexed: 12/15/2022]
Abstract
The effects of biomaterials on their environment must be carefully modulated in most biomedical applications. Among other approaches, this modulation can be obtained through the modification of the biomaterial surface. This paper proposes a simple and versatile strategy to produce non-leaching antibacterial polylactide (PLA) surfaces without any degradation of the polyester chains. The method is based on a one-pot procedure that provides a "clickable" PLA surface via anionic activation which is then functionalized with an antibacterial quaternized poly(2-(dimethylamino)ethyl methacrylate) (QPDMAEMA) by covalent immobilization on the surface. The anti-adherence and antibiofilm activities of modified PLA surfaces are assessed for different QPDMAEMA molecular weights and different quaternization agents. Antibacterial PLA surfaces are shown to be very active against Gram-negative and Gram-positive strains, with adherence reduction factors superior to 99.999% and a marked reduction in biofilm on the most potent surfaces. In addition to this substantial antibacterial activity, the proposed PLA surfaces are also cytocompatible, as demonstrated through the proliferation of L929 fibroblasts.
Collapse
|
19
|
Effectiveness of aerobic physical training for treatment of chronic asymptomatic bacteriuria in subjects with spinal cord injury: a randomized controlled trial. Clin Rehabil 2012; 27:142-9. [DOI: 10.1177/0269215512450522] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To evaluate the effectiveness and safety of aerobic physical training for treatment of chronic asymptomatic bacteriuria in subjects with spinal cord injury. Design: Randomized controlled trial. Setting: University hospital. Subjects: Forty-two participants with spinal cord injury between C8 and T12 segments were randomly assigned to intervention or control groups. Intervention: In the intervention group, subjects received a risk evaluation, stress test and urinary culture before the start of the study and after 16 weeks. The study consisted of aerobic physical conditioning with moderate intensity for the intervention group while the control group was asked to maintain their daily life activities. Main measures: Increase of estimated peak oxygen consumption and also if there was a decrease in the proportions of positive urinary culture. Results: The intervention group showed an increase of estimated peak oxygen consumption of between 939 (714–1215) and 1154 (1005–1351) mL/min ( P = 0.009) and a reduction of chronic asymptomatic bacteria of between 52.3% (29.8–74.3%) and 14.2% (3–36.3%) ( P < 0.001). No adverse effects related to physical activity were recorded during the period of training. Conclusion: The regular practice of physical activity of moderate intensity applied to patients with spinal cord injury may be an effective and safe method for the treatment of chronic asymptomatic bacteriuria.
Collapse
|