A Prospective, Randomized Trial of 3 or 14 Days of Ciprofloxacin Treatment for Acute Urinary Tract Infection in Patients with Spinal Cord Injury

Dow, Gordon; Rao, P; Harding, G. K. M.; Brunka, J.; Kennedy, J. S.; Alfa, Michelle J.; Nicolle, Lindsay E.

doi:10.1086/423000

Cited by 92 publications

(50 citation statements)

References 25 publications

(24 reference statements)

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“…Their findings indicate that treatment for 14 days leads to improved clinical and microbiological outcomes. 8 Based on the results of their meta-analysis, the authors recommend a 7-or 5-day course for UTI without fever in patients with acute or chronic SCI, respectively. UTI with fever should be always treated for 14 days.…”

Section: Discussionmentioning

confidence: 99%

Treatment of urinary tract infection in persons with spinal cord injury: guidelines, evidence, and clinical practice

Pannek

2011

The Journal of Spinal Cord Medicine

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Objectives: To investigate current clinical practice in the treatment of urinary tract infections (UTIs) in persons with spinal cord injury (SCI) in SCI centers where German is spoken and to compare it with current guidelines and evidence-based standards evaluated by a literature review. Methods: A standardized questionnaire was mailed to 16 SCI rehabilitation centers. The results were compared with a literature review Results: Of the 16 centers, 13 responded. Indications for UTI treatment, medications, and treatment duration differed substantially among the individual centers and from the existing guidelines. Antibiotic treatment is regarded as the method of choice. Compared with the existing literature, patients in two center were undertreated, whereas they were overtreated in seven centers. Conclusion: Even in specialized centers, treatment of UTI in patients with SCI is based more on personal experience of the treating physicians than on published evidence. This may at least partly be due to the paucity of evidence-based data. The observed tendency toward overtreatment with antibiotics carries substantial future risks, as this strategy may well lead to the induction of multiresistant bacterial strains. Therefore, developing guidelines would be an important step toward a unification of the different treatment strategies, thus reducing unnecessary antibiotic treatment. Furthermore, evidence-based studies evaluating the success of antibiotic treatment as well as the usefulness of alternative strategies are urgently needed.

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Section: Discussionmentioning

confidence: 99%

Treatment of urinary tract infection in persons with spinal cord injury: guidelines, evidence, and clinical practice

Pannek

2011

The Journal of Spinal Cord Medicine

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“…36 The same study group did another follow-up in 2004 with similar results. 35 The third study randomized patients to 5 or 10 days in 2014, with antimicrobials guided by gram stain. When used in conjunction with catheter exchange, rates of initial cure were similar.…”

Section: Urinary Tract Infectionsmentioning

confidence: 99%

Infections in the spinal cord-injured population: a systematic review

et al. 2016

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Study Design: Spinal cord injury (SCI) patients are an increasing population due to recent military conflicts. SCI patients are at an increased risk of infection, but the epidemiology management and prevention strategies for these infections are unclear. Objective: To review the incidence, microbiology and management of pneumonia, skin and soft tissue infections (SSTI), urinary tract infections (UTI) and bloodstream infections in the SCI population via literature review. Methods: With the assistance of an experienced medical librarian, we developed a search strategy for the Ovid MEDLINE database and then adapted it for the Ovid Embase, Scopus and Web of Science databases. The databases were searched from their inception to April 2014 with no restrictions on language or time period. Data were extracted using a standardized form. All studies were reviewed by two independent investigators. Results: Forty-one studies reporting on the described infections were identified. UTIs were the most commonly identified infections, but studies failed to identify consistently effective preventive strategies. SSTIs were also common, and the best preventive strategies focused on decubitus ulcer prevention and skin decolonization protocols. Pneumonia management and course were not significantly different from the general population. Bloodstream infections were associated with delays in recognition, and were most often secondary to UTI, pneumonia or SSTI. Conclusion: There is a paucity of literature on consistently effective infection prevention strategies in SCI patients. Identification and implementation of evidence-based interventions that optimize prevention and management of infections in this patient population are needed. Spinal Cord (2017) 55, 526-534; doi:10.1038/sc.2016.173; published online 6 December 2016 INTRODUCTIONSpinal cord injury (SCI) is a medically complex and life-disrupting condition affecting about a quarter million Americans. 1 Its incidence varies widely from country to country, but~12 000 new cases are reported each year in the United States, with a recent increase most likely associated with present military conflicts. 2,3 SCI is the result of a trauma at any level of the spinal cord causing temporary or permanent damage. Motor vehicle accidents, falls and gunshot wounds are some of the most common causes of SCI among the civilian population, responsible for 39%, 28% and 14% of cases, respectively. 3 Individuals with SCI are at high risk for both community-acquired and healthcare-associated infections due to factors such as frequent contact with the healthcare system and frequent and chronic use of invasive medical devices such as urinary and intravascular catheters. 4,5 This population is also vulnerable by limitations in clearing the airway of secretions due to restricted breathing, and abnormal sensation leading to altered or absent symptoms to indicate early infection. Bloodstream infection (BSI) is one of the most common infections leading to hospital admission, followed by urinary tract infection ...

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“…Because of the wide variation in underlying abnormalities and clinical presentations, a uniform recommendation for treatment duration is likely not appropriate. Most clinical trials have evaluated 7 to 14 d of therapy, but as short as five days and as long as 20 d have been reported [19].…”

Section: Discussionmentioning

confidence: 99%

“…Most clinical trials have evaluated 7 to 14 d of therapy, but as short as five days and as long as 20 d have been reported [13]. Keeping in view the above mentioned factors in view, the present study was designed to evaluate efficacy and tolerability of cefotaxime and sulbactam versus cefepime and tazobactam in patients of urinary tract infection.…”

mentioning

confidence: 99%

Evaluation of Efficacy and Tolerability of Cefotaxime and Sulbactam Versus Cefepime and Tazobactam in Patients of Urinary Tract Infection-A Prospective Comparative Study

Kaur

Gupta

Sharma

et al. 2014

JCDR

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A Prospective, Randomized Trial of 3 or 14 Days of Ciprofloxacin Treatment for Acute Urinary Tract Infection in Patients with Spinal Cord Injury

Abstract: For patients with spinal cord injury, treatment of acute symptomatic UTI for 14 days leads to improved clinical and microbiological outcomes, compared with short-course therapy.

Cited by 92 publications

References 25 publications

Treatment of urinary tract infection in persons with spinal cord injury: guidelines, evidence, and clinical practice

Treatment of urinary tract infection in persons with spinal cord injury: guidelines, evidence, and clinical practice

Infections in the spinal cord-injured population: a systematic review

Evaluation of Efficacy and Tolerability of Cefotaxime and Sulbactam Versus Cefepime and Tazobactam in Patients of Urinary Tract Infection-A Prospective Comparative Study

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