Increasing Resistance against Antibiotics in Bacteria Isolated from the Lower Urinary Tract of an Outpatient Population of Spinal Cord Injury Patients

Hinkel, Andreas; Finke, W; Bötel, U; Gatermann, Sören; Pannek, J.

doi:10.1159/000079695

Cited by 36 publications

(29 citation statements)

References 7 publications

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“…patients, not only hospital but also community-residing patients have problems associated with antibiotic-resistant bacterial colonization or infection due to catheter-associated voiding and frequent antibiotics usage. 5,6,14 However, compared with community-dwelling patients, isolates from hospital-dwelling SCI patients showed higher resistance rates to the majority of antimicrobial agents that were investigated. In related studies, trimethoprim-sulfamethoxazole, amoxicillinclavulanic acid and second or third generation of cephalosporins are generally recommended for the empirical treatment of UTI in patients with SCI.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of bacterial strains and antibiotic susceptibilities in urinary isolates of spinal cord injury patients from the community and hospital

Yoon

Lee

et al. 2014

Spinal Cord

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Study design: A one-year epidemiological survey. Objective: To compare bacterial strains and antimicrobial susceptibilities of urinary isolates from hospital and community spinal cord injury (SCI) patients. Setting: A specialized SCI unit in a freestanding rehabilitation hospital. Methods: From June 2012 through May 2013, urine cultures were obtained from all of the newly admitted patients. Bacterial strains and antimicrobial susceptibilities were compared between patients from community and hospital settings. Results: The proportion of Enterobacteriaceae in the total urinary isolates from hospital-dwelling patients was smaller than that from community-dwelling patients (66.0 vs 85.5%, Po0.001), while the proportions of Pseudomonas, Acinetobacter and Enterococcus species were relatively larger (8.7%, 6.0% and 12.0% vs 2.8%, 0.7% and 2.8%, respectively, Po0.05). The isolates from hospitaldwelling patients showed lower susceptibility to ampicillin, amoxicillin-clavulanic acid, trimethoprim-sulfamethoxazole and all generations of cephalosporin (Po0.05), and a higher prevalence of extended-spectrum beta-lactamase (ESBL)-producers (41.7 vs 5.4%, Po0.001), compared with those from community-dwelling patients. The susceptibility rates to levofloxacin were lower than 50% in both community and hospital-dwelling patients. Conclusion: Broader-spectrum antibiotics should be considered in treating nosocomial urinary tract infection (UTI) of SCI patients because of the relatively wide variety of organisms and higher frequency of antibiotic-resistant strains, including ESBL-producing Enterobacteriaceae in hospital-derived specimens. Furthermore, in areas with high prevalence of fluoroquinolone resistance, fluoroquinolones should be used with caution during empirical treatment for UTI in SCI patients.

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Section: Discussionmentioning

confidence: 99%

“…[5][6][7] The results of these studies may help to select proper antimicrobial agents during empirical therapy for UTI. However, these studies have only assessed the outpatient SCI population.…”

Section: Introductionsmentioning

confidence: 99%

Comparison of bacterial strains and antibiotic susceptibilities in urinary isolates of spinal cord injury patients from the community and hospital

Yoon

Lee

et al. 2014

Spinal Cord

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“…The authors concluded that antibiotic treatment should be limited to symptomatic UTIs and be initiated after sensitivity testing only. 15 Until today, however, no data concerning a safe and effective alternative treatment are available. Thus, antibiotic prophylaxis seems to be the method of choice today.…”

Section: Abbreviation: Uti Urinary Tract Infectionmentioning

confidence: 99%

Morbidity of urodynamic testing in patients with spinal cord injury: is antibiotic prophylaxis necessary?

Pannek

Nehiba

2007

Spinal Cord

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Study Design: Prospective, non-randomized study. Objectives: To assess the incidence of urinary tract infection after urodynamics in patients with spinal cord injury. Setting: Outpatient clinic of a university hospital in Germany. Methods: Urinary tract infection and clinical symptoms in 109 consecutive outpatients with spinal cord injury following urodynamic evaluation were studied. Results: Data from 72 patients were evaluable. Of these, seven patients (9.7%) developed a significant urinary tract infection. Five of these were symptomatic. Pre-existing asymptomatic bacteriuria was not associated with a higher risk for post-interventional infection. The technique of the bladder management did not correlate with urinary tract infection rates. Conclusion: In this study, symptomatic urinary tract infections after cystometry were not infrequent. Therefore, it seems that antibiotic prophylaxis cannot be omitted in patients with spinal cord injury undergoing urodynamic investigation.

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“…UTIs are considerably more frequent because of urinary catheter use, residual urine in the bladder due to incomplete emptying, renal stones, obstructed urinary outflow, dysregulation of the autonomic nervous system, and an unbalanced bladder evacuation. These are significant causes of morbidity and mortality (1,2). Although UTIs occur in 22% of patients with acute SCI in the first 50 days, the UTI prevalence is approximately 20% in patients with chronic SCI (3).…”

Section: Introductionmentioning

confidence: 99%

Characteristics of Urinary Tract Infections in Patients with Spinal Cord Injuries Hospitalized at a Rehabilitation Centre

Albayrak¹,

Çalışkan²,

Levendoğlu³

et al. 2016

Cyprus J Med Sci

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BACKGROUNDThe aims of this study were to determine the prevalence of urinary tract infections (UTIs), identify the most frequently isolated pathogens associated with UTIs, and evaluate the antimicrobial susceptibility of these pathogens in spinal cord injury (SCI) patients. MATERIAL and METHODSA total of 91 patient charts were retrospectively evaluated in this study. The demographic data of these patients, length of hospital stay, SCI data, mode of bladder emptying, number of UTI episodes, microorganisms isolated by urine culture, and antimicrobial susceptibility tests were recorded. RESULTSOf the 91 SCI patients, 53 were males and 38 were females, with a mean age of 45.29 (±17.87) years. A total of 47 UTI episodes were recorded in 38 SCI patients, nine of whom had experienced two episodes. The prevalence of UTI was 41.7% (38/91). The most frequently isolated pathogen was Escherichia coli (57.4%). The antimicrobial agents were most frequently susceptible were gentamicin (72.3%), piperacillin/ tazobactam (57.4%), and meropenem (48.9%). CONCLUSIONThe UTI prevalence in patients with SCI was considerably high. E. coli was the most common uropathogen, and gentamicin was the most frequently used antimicrobial agent. Keywords: Spinal cord injury, urinary tract infection, epidemiology INTRODUCTIONThe risk of urinary tract infections (UTIs) is higher in patients with a spinal cord injury (SCI) because of a lack of normal physiological urination resulting from neurogenic bladder in most patients. UTIs are considerably more frequent because of urinary catheter use, residual urine in the bladder due to incomplete emptying, renal stones, obstructed urinary outflow, dysregulation of the autonomic nervous system, and an unbalanced bladder evacuation. These are significant causes of morbidity and mortality (1, 2). Although UTIs occur in 22% of patients with acute SCI in the first 50 days, the UTI prevalence is approximately 20% in patients with chronic SCI (3). UTIs were detected in 60% of SCI patients in a rehabilitation center study in Thailand (4). A mortality rate of nearly 34% is reported in patients with SCI due to urinary sepsis, and this is the second most frequent cause of death in patients with SCI (5, 6).

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Increasing Resistance against Antibiotics in Bacteria Isolated from the Lower Urinary Tract of an Outpatient Population of Spinal Cord Injury Patients

Cited by 36 publications

References 7 publications

Comparison of bacterial strains and antibiotic susceptibilities in urinary isolates of spinal cord injury patients from the community and hospital

Comparison of bacterial strains and antibiotic susceptibilities in urinary isolates of spinal cord injury patients from the community and hospital

Morbidity of urodynamic testing in patients with spinal cord injury: is antibiotic prophylaxis necessary?

Characteristics of Urinary Tract Infections in Patients with Spinal Cord Injuries Hospitalized at a Rehabilitation Centre

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