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Alshahri S, Alghaiheb A, Alanazi A, Alshammari S, Alomair A. Antibiogram data of urinary tract infection in spinal cord injury patients in an outpatient setting. NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2024; 29:57-62. [PMID: 38195136 PMCID: PMC10827016 DOI: 10.17712/nsj.2024.1.20230063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 12/04/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVES To establish antibiogram data for patients with spinal cord injury (SCI) that would help differentiate the organisms commonly present depending on the voiding method and antibiotic sensitivity for empirical treatment. METHODS A total of 499 urine culture results were obtained from 151 SCI patients with symptomatic urinary tract infection (UTI) with significant bacteriuria and pyuria with more than 10 white blood cells per high power field. The voiding method was categorized as follows: self-intermittent catheterization (SIC), suprapubic catheter (SPC), Foley catheter, condom catheter, or voiding freely. RESULTS The demographic data were as follows: male, n=124 (82.2%); female, n=27 (17.8%); mean age, 39; paraplegic n=105 (69.5%); and tetraplegic, n=45 (29.8%). The SIC was the most common voiding method (n=64, 42.3%), followed by Foley catheter (n=39, 25.8%). Escherichia coli was the most common organism overall (29%) and more frequent in patients using SIC as the voiding method. Proteus mirabilis was present more frequently in patients using SPC (33%), and Klebsiella pneumoniae in voiding freely cultures (30%). Antibiotic sensitivity was as follows Gentamicin (44.1%), Nitrofurantoin (39.1%), Augmentin (33.5%), and Ciprofloxacin (31.5%). CONCLUSION Increased preference of the local population to foley catheter as a voiding method which needs to be investigated more. The type of voiding methods in patients with SCI results in different common causative organisms of UTI. Ciprofloxacin resistance profile increased overall except in patients voiding with SPC. Nitrofurantoin is the most overall sensitive oral antibiotic in our sample followed by Augmentin then Cefuroxime.
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Affiliation(s)
- Saeed Alshahri
- From the Functional Care Services, Department of Rehabilitation Medicine, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Abdullah Alghaiheb
- From the Functional Care Services, Department of Rehabilitation Medicine, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Abdullah Alanazi
- From the Functional Care Services, Department of Rehabilitation Medicine, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Sultanah Alshammari
- From the Functional Care Services, Department of Rehabilitation Medicine, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Abdullah Alomair
- From the Functional Care Services, Department of Rehabilitation Medicine, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
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Davis M, Jethani L, Robbins E, Kaner M. Is It Really the Foley? A Systematic Review of Bladder Management and Infection Risk. Top Spinal Cord Inj Rehabil 2023; 29:94-107. [PMID: 36819923 PMCID: PMC9936901 DOI: 10.46292/sci22-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Background The belief that intermittent catheterization results in fewer infections than indwelling catheters is commonly expressed in the spinal cord injury literature. Some practice guidelines strongly recommend intermittent over indwelling catheterization due to concerns about infections and other complications. However, studies on this topic are of low quality. Guidelines from the Consortium for Spinal Cord Medicine suggest the data regarding infection risk are mixed, and they do not recommend one bladder management method over the other. Objectives To compare risk of bias in studies reporting higher rates of urinary tract infection (UTI) with indwelling catheters to studies that found equal rates of UTI between indwelling and intermittent catheterization, and to describe implications in clinical decision-making. Methods A systematic search of PubMed, CINAHL, Embase, and SCOPUS databases from January 1, 1980, to September 15, 2020, was conducted. Eligible studies compared symptomatic UTI rates between indwelling and intermittent catheterization. We used a risk of bias assessment tool to evaluate each study. Results Twenty-four studies were identified. Only three of these reported significantly higher UTI risk with indwelling catheters, and all three demonstrated a critical risk of bias. More than half of the studies reported differences in UTI risk of less than 20% between the two methods. Studies with larger (nonsignificant) differences favoring intermittent catheterization were more susceptible to bias from confounding. Conclusion The hypothesis that indwelling catheters cause more UTIs than intermittent catheterization is not supported by the scientific literature. Most studies failed to demonstrate a significant difference in UTI risk, and studies with nonsignificant trends favoring intermittent catheterization were more susceptible to bias from confounding. Perceived risk of infection should not influence a patient's choice of catheter type.
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Affiliation(s)
- Matthew Davis
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, Houston, Texas
| | - Lavina Jethani
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, Houston, Texas
| | - Emily Robbins
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, Houston, Texas
| | - Mahmut Kaner
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, Houston, Texas
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Šámal V, Paldus V, Fáčková D, Mečl J, Šrám J. The prevalence of antibiotic-resistant and multidrug-resistant bacteria in urine cultures from inpatients with spinal cord injuries and disorders: an 8-year, single-center study. BMC Infect Dis 2022; 22:239. [PMID: 35264096 PMCID: PMC8908566 DOI: 10.1186/s12879-022-07235-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background Patients, especially inpatients, with spinal cord lesions and disorders (SCI/D) have an elevated risk of recurrent urinary tract infections with multidrug resistant (MDR) bacteria. This study evaluated antimicrobial resistance and the prevalence of multidrug resistance and determined the risk factors for multidrug resistance. Methods In this retrospective cohort study, urine culture results were used to calculate the antimicrobial resistance rate and the incidence of infection with MDR bacteria in the SCI/D population. MDR was defined as acquired nonsusceptibility to at least one agent from three or more antimicrobial categories. The cohort included 402 inpatients from 2013 to 2020, with 1385 urine isolates. We included only the first isolate; duplicate isolates, defined as positive cultures of the same strain within 14 days, were excluded from the evaluation. Results The most common MDR strains were Klebsiella spp. (29%) and Escherichia coli (24%). MDR isolates were detected in 50% of the samples and extended spectrum beta-lactamase (ESBL)-producing isolates were detected in 26%, while carbapenem resistance was found in 0.1%. Significantly higher rates of infection with MDR bacteria were identified in groups of patients with indwelling urethral/suprapubic catheters (p = 0.003) and severity scores of C1–C4/AIS A–C (p = 0.01). We identified age (OR: 0.99, 95% CI; 0.98–0.99, p = 0.000), sex (OR: 1.55, 95% CI; 1.16–2.06, p = 0.003), management with urethral/suprapubic catheters (OR: 2.76, 95% CI; 2.04–3.74, p = 0.000), and spontaneous voiding (OR: 1.84, 95% CI; 1.03–3.29, p = 0.038) as independent predictors of multidrug resistance in our study population. Conclusions We identified a high antibiotic resistance rate and an increasing prevalence of infection with MDR bacteria in the SCI/D inpatient population. Particular attention should be given to bladder management, with an emphasis on minimizing the use of indwelling catheters.
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Affiliation(s)
- Vladimír Šámal
- Department of Urology, Krajská Nemocnice Liberec, Husova 10, 46063, Liberec, Czech Republic.
| | - Vít Paldus
- Department of Urology, Krajská Nemocnice Liberec, Husova 10, 46063, Liberec, Czech Republic
| | - Daniela Fáčková
- Department of Microbiology, Krajská Nemocnice Liberec, Liberec, Czech Republic
| | - Jan Mečl
- Department of Urology, Krajská Nemocnice Liberec, Husova 10, 46063, Liberec, Czech Republic
| | - Jaroslav Šrám
- Traumatology and Orthopedics Center, Krajská Nemocnice Liberec, Liberec, Czech Republic
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Multidrug-resistant bacteria in urine culture among patients with spinal cord injury and disorder: Time to first detection and analysis of risk factors. Spinal Cord 2022; 60:733-738. [PMID: 35197573 DOI: 10.1038/s41393-022-00774-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 02/06/2022] [Accepted: 02/08/2022] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES The aim of this study was to assess the time to first detection of multidrug-resistant bacteria (MDRB) in urine culture and identify risk factors associated with the first detection of MDRB (1st MDRB). SETTING Spinal Care Ward and Department of Microbiology, Regional Hospital Liberec a.s., Liberec, Czech Republic. METHOD We cultured urine samples from patients in the acute phase of spinal cord injury or disorder (SCI/D). Multidrug resistance (MDR) was defined as acquired nonsusceptibility to at least one agent from three or more antimicrobial categories. Multivariate logistic regression was used to assess the association of bladder management, broad-spectrum antibiotic exposure, mechanical ventilation, pressure ulcers, positive urine culture on admission, and other risk factors with 1st MDRB. We used only the first urine culture with MDRB for evaluation. RESULTS A total of 655 urine cultures from 246 individuals were evaluated, and 829 isolates were obtained. The MDRB prevalence among all isolates was 40.2%. MDRB was detected in 146 (59.3%) patients for the first time, and 76.0% of these isolates were from patients with asymptomatic bacteriuria. The median time to 1st MDRB was 37 days (95% CI, 33-41). According to multivariate logistic regression, 1st MDRB was associated with bladder management with urethral or suprapubic catheterization (OR: 2.8, 95% CI, 1.1-7.2). CONCLUSION The prevalence of infections caused by MDRB was high among the SCI/D population, with three-quarters from patients with asymptomatic bacteriuria. Bladder management with an indwelling catheter is associated with an increased risk of 1st MDRB.
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Goswami T, Krishnamurthy M, Varghese S. A study on the pathogenic microbes and antibiotic-sensitivity patterns in urinary tract infection among diabetes patients at a tertiary care hospital in Central Kerala. JOURNAL OF CURRENT RESEARCH IN SCIENTIFIC MEDICINE 2022. [DOI: 10.4103/jcrsm.jcrsm_15_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Wong BTH, Kan SCF, Lo AHK, Ho LY, Kan RWM, Lai C. Asian guidelines for UTIs & STIs UTI section: Complicated UTIs with neurogenic bladder. J Infect Chemother 2021; 28:6-9. [PMID: 34702637 DOI: 10.1016/j.jiac.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 09/24/2021] [Accepted: 10/13/2021] [Indexed: 10/28/2022]
Abstract
EPIDEMIOLOGY AND PATHOGENESIS Urinary tract infection (UTI) in patients with neurogenic bladder causes significant morbidity and mortality. DIAGNOSIS UTI in neurogenic bladder causes atypical symptomatology. Urine tests are pivotal in confirming or excluding UTI, and in guiding appropriate antibiotic treatment. TREATMENT 1. Symptomatic UTI warrants appropriate antibiotic treatment with reference to culture results and local antibiotic resistance patterns. Asymptomatic bacteriuria should not be treated, and antibiotic prophylaxis is generally not recommended.2. Adequate bladder drainage is essential in reducing the occurrence of urinary tract infections.3. Recurrent UTI in neurogenic bladder may necessitate the treatment of neurogenic detrusor overactivity and the restoration of low bladder pressure during bladder storage and voiding by drugs or surgery.
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Affiliation(s)
| | - Stanley Chi Fai Kan
- Division of Urology, Department of Surgery, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | | | - Lap Yin Ho
- Division of Urology, Department of Surgery, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Raymond Wai Man Kan
- Division of Urology, Department of Surgery, Queen Elizabeth Hospital, Kowloon, Hong Kong.
| | - Christopher Lai
- Department of Microbiology, Chinese University of Hong Kong, Hong Kong
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Pediatric Urodynamic Study Without a Preprocedural Urine Culture, Is It Safe in Clinical Practice? Urology 2020; 145:224-228. [DOI: 10.1016/j.urology.2020.07.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 11/19/2022]
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Barriers and facilitators to optimising inpatient bladder management after spinal cord injury. Spinal Cord 2020; 58:1291-1300. [PMID: 32457515 DOI: 10.1038/s41393-020-0487-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Qualitative survey. OBJECTIVES Examine clinicians' perspectives on adherence to published evidence-based guidelines and clinician-perceived barriers, and facilitators to optimising inpatient bladder management within one Spinal Cord Injury (SCI) service. SETTING Surgical Hospital (acute care) and SCI Unit (sub-acute, rehabilitation) in Western Australia (WA). METHODS Clinicians reviewed an 'Evidence Matrix' summarising published clinical practice guidelines and recommendations for SCI bladder management. Focus groups examined the extent to which current practice adhered to recommendations and identified perceived barriers and facilitators to optimal management. Data were analysed thematically using a deductive approach. RESULTS Current management closely mirrors published recommendations. Key facilitators included long-standing prioritisation of rapid progression from urethral indwelling (IDC) to a 6 hourly intermittent catheterisation (IC) protocol; regular competency audits of catheterisation technique; and a Spinal Urology Clinical Nurse Consultant (CNC) position. Barriers included limited resources/staffing; restricted access to Neuro-urology consultation; inter-disciplinary communication gaps; and delays in determining and implementing long-term bladder management. CONCLUSIONS Inpatient SCI bladder care in WA closely emulates published evidence, although adherence at other sites may reveal different practices. Bladder management was found to have been facilitated by a strong culture of practice led by Neuro-urologists, informed by evidence and embraced by Senior Clinicians. Further reduction in duration of initial IDC, provision of early and ongoing Neuro-urology consultations as part of standard care, increased interdisciplinary communication and dedicated SCI Urology theatre lists would further optimise management.
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Goodes LM, King GK, Rea A, Murray K, Boan P, Watts A, Bardsley J, Hartshorn C, Thavaseelan J, Rawlins M, Brock JA, Dunlop SA. Early urinary tract infection after spinal cord injury: a retrospective inpatient cohort study. Spinal Cord 2019; 58:25-34. [PMID: 31388122 DOI: 10.1038/s41393-019-0337-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/05/2019] [Accepted: 07/10/2019] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective audit. OBJECTIVES Examine factors associated with urinary tract infection (UTI), UTI incidence and impact on hospital length of stay (LOS) in new, inpatient adult traumatic spinal cord injury (SCI). SETTING Western Australian Hospitals managing SCI patients. METHODS Data on UTIs, bladder management and LOS were obtained from hospital databases and medical records over 26 months. Adherence to staff-administered intermittent catheterisation (staff-IC) was determined from fluid balance charts. RESULTS Across the cohort (n = 70) UTI rate was 1.1 starts/100 days; UTI by multi-resistant organisms 0.1/100 days. Having ≥1 UTIs compared with none and longer duration of initial urethral indwelling catheterisation (IDC) were associated with longer LOS (p-values < 0.001). For patients with ≥1 UTIs (n = 43/70), longer duration of initial IDC was associated with shorter time to first UTI (1 standard deviation longer [SD, 45.0 days], hazard ratio (HR): 0.7, 95% confidence interval [CI] 0.5-1.0, p-value 0.044). In turn, shorter time to first UTI was associated with higher UTI rate (1 SD shorter [30.7 days], rate ratio (RR): 1.32, 95%CI 1.0-1.7, p-value 0.039). During staff-IC periods (n = 38/70), protocols were followed (85.7% ≤ 6 h apart, 96.1% < 8 h), but 26% of IC volumes exceeded 500 mL; occasional volumes > 800 mL and interruptions requiring temporary IDC were associated with higher UTI rates the following week (odds ratios (ORs): 1.6, 95%CI 1.1-2.3, p-value 0.009; and 3.9, 95%CI 2.6-5.9, p-value < 0.001 respectively). CONCLUSIONS Reducing initial IDC duration and limiting staff-IC volumes could be investigated to possibly reduce inpatient UTIs and LOS. SPONSORSHIP None.
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Affiliation(s)
- Louise M Goodes
- School of Biological Sciences, The University of Western Australia, Crawley, WA, Australia
| | - Gabrielle K King
- School of Biological Sciences, The University of Western Australia, Crawley, WA, Australia
| | - Alethea Rea
- Centre for Applied Statistics, The University of Western Australia, Crawley, WA, Australia
| | - Kevin Murray
- School of Population and Global Health, The University of Western Australia, Crawley, WA, Australia
| | - Peter Boan
- Departments of Microbiology and Infectious Diseases, Fiona Stanley Hospital and PathWest Laboratory Medicine, Murdoch, WA, Australia
| | - Anne Watts
- State Rehabilitation Service, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Jen Bardsley
- State Rehabilitation Service, Fiona Stanley Hospital, Murdoch, WA, Australia
| | | | | | - Matthew Rawlins
- Department of Pharmacy, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - James A Brock
- Department of Anatomy and Neuroscience, University of Melbourne, Parkville, VIC, Australia
| | - Sarah A Dunlop
- School of Biological Sciences, The University of Western Australia, Crawley, WA, Australia.
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Kang MS, Lee BS, Lee HJ, Hwang SW, Han ZA. Prevalence of and Risk Factors for Multidrug-Resistant Bacteria in Urine Cultures of Spinal Cord Injury Patients. Ann Rehabil Med 2015; 39:686-95. [PMID: 26605166 PMCID: PMC4654075 DOI: 10.5535/arm.2015.39.5.686] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 05/11/2015] [Indexed: 11/24/2022] Open
Abstract
Objective To identify the prevalence of multidrug-resistant (MDR) bacteria and identify their specific risk factors in routine urine specimens of spinal cord injury (SCI) patients. Methods This study was designed in a retrospective manner, reviewing the medical records of SCI patients who were admitted to a specialized SCI unit between January 2001 and December 2013. Patients were investigated for age, gender, American Spinal Injury Association impairment scale, SCI level, duration after injury, bladder management method, and hospitalization history within four weeks prior to visiting our unit. The results of routine urine cultures including presence of MDR organisms were analyzed. Results Among the total 2,629 urine samples from the newly admitted SCI patients, significant bacteriuria was identified in 1,929 (73.4%), and MDR organisms were isolated in 29 (1.1%) cultures. There was an increasing trend of MDR organism prevalence from 2001 to 2013 (p<0.01). The isolation of MDR organisms in inpatients who were admitted for rehabilitation (1.3%) was significantly higher than it was among community-residing persons (0.2%) (p<0.05). By voiding method, patients who used a suprapubic indwelling catheter (3.3%) or a urethral indwelling catheter (2.6%) showed a higher rate of MDR organism isolation (p<0.05). Conclusion There was an increasing trend of MDR organism isolation in SCI patients. Inpatients and persons who used indwelling catheters showed a higher risk of MDR organism isolation.
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Affiliation(s)
- Min-Soo Kang
- Department of Physical Medicine and Rehabilitation, National Rehabilitation Center, Seoul, Korea
| | - Bum-Suk Lee
- Department of Physical Medicine and Rehabilitation, National Rehabilitation Center, Seoul, Korea
| | - Hye-Jin Lee
- Department of Physical Medicine and Rehabilitation, National Rehabilitation Center, Seoul, Korea
| | - Seung-Won Hwang
- Department of Physical Medicine and Rehabilitation, National Rehabilitation Center, Seoul, Korea
| | - Zee-A Han
- Department of Physical Medicine and Rehabilitation, National Rehabilitation Center, Seoul, Korea
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Grigoryan L, Abers MS, Kizilbash QF, Petersen NJ, Trautner BW. A comparison of the microbiologic profile of indwelling versus external urinary catheters. Am J Infect Control 2014; 42:682-4. [PMID: 24837121 DOI: 10.1016/j.ajic.2014.02.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 02/28/2014] [Accepted: 02/28/2014] [Indexed: 10/25/2022]
Abstract
We studied the microbiology reports of urine cultures collected from external (condom catheters) versus indwelling (Foley) catheters. The equal prevalence of Enterobacteriaceae and Enterococci in samples from both catheter types calls into question the practice of switching from indwelling to external catheters to decrease catheter-associated bacteriuria.
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Bacterial Persistence in the Prostate After Antibiotic Treatment of Chronic Bacterial Prostatitis in Men With Spinal Cord Injury. Urology 2014; 83:515-20. [DOI: 10.1016/j.urology.2013.11.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 11/14/2013] [Accepted: 11/20/2013] [Indexed: 11/22/2022]
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Bladder stones in patients with spinal cord injury: a long-term study. Spinal Cord 2014; 52:295-7. [PMID: 24469146 DOI: 10.1038/sc.2014.1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 12/20/2013] [Accepted: 01/03/2014] [Indexed: 12/14/2022]
Abstract
STUDY DESIGN Retrospective follow-up study. OBJECTIVES To assess the occurrence of bladder stones in patients with spinal cord injury (SCI). SETTING Single SCI rehabilitation center in Switzerland. METHODS We searched our database for SCI patients who had undergone surgery due to bladder stones between 2004 and 2012. In all patients retrieved, personal characteristics, bladder management, bladder stone occurrence and time to stone formation/recurrence were recorded. RESULTS We identified 93 (3.3%) of 2825 patients with bladder stones, 24 women and 69 men, with a mean age 50 years (17-83) years. We observed bladder stones in patients with suprapubic catheter (SPC) in 11% (50/453), transurethral catheter (TC) in 6.6% (5/75), with intermittent catheterization (IC) in 2% (27/1315) and with reflex micturition (RM) in 1.1% (11/982), respectively. The mean time period to stone development was 95 months. The TC group had the shortest time interval (31 months), followed by the SPC group (59 months), individuals performing IC (116 months) and RM (211 months), respectively. Bladder stone recurrence rate was 23%. Recurrences were most frequent in the TC group (40%), followed by SPC (28%) and IC (22%), whereas no recurrences occurred in the RM group. Time to recurrence was shortest in the SPC group (14 months), followed by the IC (26 months) and the TC group (31 months), respectively. CONCLUSION In SCI patients, bladder management has an important role in the development of bladder stones. Indwelling catheters (TC/SPC) are associated with the highest risk to develop bladder stones and therefore should be avoided if possible. If unavoidable, SPC are superior to TC.
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Böthig R, Fiebag K, Thietje R, Faschingbauer M, Hirschfeld S. Morbidity of urinary tract infection after urodynamic examination of hospitalized SCI patients: the impact of bladder management. Spinal Cord 2012; 51:70-3. [PMID: 22964752 DOI: 10.1038/sc.2012.107] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Non-interventional, descriptive-observational cohorts study. OBJECTIVES To assess the incidence of urinary tract infection (UTI) after urodynamic examination in patients with spinal cord injury (SCI) according to bladder management. SETTING Level 1 trauma center. METHODS Between January and December 2010 a total of 133 consecutive, hospitalized SCI patients were included and classified according to their bladder management. Urine specimen was obtained at the beginning of the urodynamic studies (UDS) and 3-5 days thereafter. 'Significant bacteriuria' (SBU) is defined by a CBU per ml level ≥10(5) in a urine culture. UTI thus is defined as a combination of a SBU and ≥100 leukocytes per μl in urine analysis. RESULTS The overall incidence of UTI post UDS was 15.79%. In patients with sterile urine prior to urodynamics UTI was ascertained in 8.6% (de-novo-UTI). In contrast, 32.5% of the patients with SBU prior to UDS showed UTI 3 days later. There were only minor differences in the incidence of de-novo-UTIs in SCI patients who emptied their bladder by intermittent self catheterization or intermittent catheterization by attendant (8.82% and 6.67%, respectively). In SCI patients with reflex voiding however, the frequency of de-novo-UTIs was twice as high (14.28%). CONCLUSION The recommendation of antibiotic prophylaxis for all SCI patients undergoing urodynamic examination is not commonly accepted and according to our data not justified. However, the analysis of subgroups revealed that SCI patients with unsuspected SBU prior to UDS and patients with reflex voiding are possibly at higher risk to acquire post-UDS infection.
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Affiliation(s)
- R Böthig
- Department Neuro-Urology, BG Trauma Hospital Hamburg, Hamburg, Germany.
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Sahai A, Cortes E, Seth J, Khan MS, Panicker J, Kelleher C, Kessler TM, Fowler CJ, Dasgupta P. Neurogenic detrusor overactivity in patients with spinal cord injury: evaluation and management. Curr Urol Rep 2012; 12:404-12. [PMID: 21964989 DOI: 10.1007/s11934-011-0221-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Lower urinary tract dysfunction can have a significant impact on patients with spinal cord injury. Over the years, many treatment options have become available. This article reviews the assessment and management of neurogenic detrusor overactivity, with a particular focus on articles from the recent literature. Recent guidelines on the subject will be discussed. Management options include antimuscarinics and bladder emptying measures, botulinum toxin A, and neuromodulation in refractory cases and surgery for intractable cases. Recent and relevant publications in these areas will be summarized and discussed.
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Affiliation(s)
- Arun Sahai
- Department of Urology & Medical Research Council (MRC) Centre for Transplantation, King's College London, King's Health Partners, Guy's Hospital, London, UK.
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