Infectious Complications after Spinal Cord Injury

Abstract

Infectious diseases after spinal cord injury (SCI) are important. They can cause mortality and morbidity. The SCI patients usually stay in hospital or rehabilitation units for a long time, and this can cause several complications for them. Infectious complications: There are several infectious complications in these patients. Pressure ulcers that may be infected, soft tissue infections, osteomyelitis, pneumonia, urinary tract infection, bacteremia, meningitis, epidural abscess, and subdural empyema are important complications. These diseases should be diagnosed and managed promptly, before leading to irreversible complications or death. Diagnosis: Diagnosis is made by physical examinations; laboratory tests like wound, urine, tracheal secretion, and blood culture with antibiogram; and radiologic evaluation like plain X-ray and magnetic resonance imaging may be used. Treatment: Appropriate antibiotics are cornerstone of infectious complications. Offloading is important for treatment of pressure ulcers and subsequent complications such as soft tissue infection and osteomyelitis. Prevention: Intermittent urinary catheterization and prophylactic antibiotic therapy can decrease UTI. Pressure relief, position changes, and regular and frequent observation of skin will prevent pressure ulcers, soft tissue infections, and osteomyelitis. Pulmonary toilet, appropriate positioning, and cough assistance can be useful for clearing retained secretions and preventing pneumonia.

A demographic profile of cervical injury: an Indonesian single tertiary hospital study with 6 months to 1-year follow-up

“…Respiratory failure in SCI was caused by several mechanisms including weakness of the respiratory muscles, impaired cardiovascular function and autonomic nerves, pulmonary edema, prolonged bed rest, and impaired cough function [16]. While sepsis in cervical injury patients could be caused by several pathologies, including urinary tract infection due to repeated insertion of Foley catheters or impairment of bladder emptying, skin and soft tissue infection, such as pressure ulcer, surgical osteomyelitis, and pneumonia due to sputum retention [17].…”

A Rare Case of Carpal Osteomyelitis in a Spinal Cord Injury Patient: A Case Report

“…Although not the most common infection in the SCI population, osteomyelitis can frequently develop from an extension of infection from pressure ulcers. The individual’s inability to change position due to impaired motor function or decreased sensation leads to reduced tissue perfusion, thus increasing the patient’s susceptibility to developing pressure ulcers [ 2 ]. The most common source of osteomyelitis in SCI patients is a local infection from pressure ulcers at bony prominences, which include sacrum, ischial tuberosity, trochanteric area, and malleoli [ 1 , 2 ].…”

“…The individual’s inability to change position due to impaired motor function or decreased sensation leads to reduced tissue perfusion, thus increasing the patient’s susceptibility to developing pressure ulcers [ 2 ]. The most common source of osteomyelitis in SCI patients is a local infection from pressure ulcers at bony prominences, which include sacrum, ischial tuberosity, trochanteric area, and malleoli [ 1 , 2 ]. The localization of osteomyelitis involving the hand or wrist is uncommon in the general population, especially in the absence of trauma or other sites of boney infection [ 3 ].…”

Infectious diseases as complications following spinal cord injury

“…6,7 Not only do infectious complications hold a bigger risk of morbidity and mortality but also precipitate higher cost of management. 8…”

“…Acute abdominal emergencies such as gastrointestinal bleeding, peptic ulcer perforation, and pancreatitis are often missed since the loss of sensation circumstances. 8…”