Prevention of urinary tract infection in patients with spinal cord injury – a microbiological review

Abstract

The importance of urinary tract infection (UTI) in patients with spinal cord injury cannot be understated. Many patients with signi®cant bacteriuria are considered to be colonised rather than infected, and treatment should be reserved for those with clinical symptoms or other signs of infection. 1 Published research on the prevention and management of UTI in patients with spinal cord injury often has limitations due to di erences in de®nitions of UTI, studies on groups using di erent urinary drainage appliances, the mixture of newly injured and longstanding injured patients and studies being carried out predominantly on male patients. 2 The complications due to UTI and the di culties in treating established infection mean that prevention is essential. Close urological follow-up is crucial in ensuring that adequate bladder drainage is achieved avoiding the use of long term indwelling urinary catheters if at all possible. 3 For those patients who require long term urinary appliances patient education and strict attention to hygiene and catheter care policies is important. The role of antiseptic/ antibiotics is strictly limited in preventing UTI in patients with spinal cord injury and may even be harmful. Further study into which groups of patients may bene®t from the use of antiseptics or antibiotics is urgently required. Continued research into di erent methods of prevention eg by vaccination, immunotherapy, the use of receptor analogues and bladder interference should also be encouraged.

May we go on with antibacterial prophylaxis for urinary tract infections?

“…In neurogenic bladder dysfunction, the question of efficacy of antibacterial prophylaxis is also not yet sufficiently answered [43]. Whereas, several studies showed a positive effect of antibacterial prophylaxis [44,45], many authors did not find any superiority to placebo [46,47].…”

Long-Term Complications of Chronic Traumatic Paraplegia: An Experience from Pakistan

“…It can give rise to the complications like pyelonephritis, renal/bladder stones, renal failure, and death [1,14]. In this study, 100% patients were suffering from asymptomatic bacteriuria.…”

“…Bosnian study reported Providencia and Proteus as the frequent isolated organisms [10]. Pseudomonas aeruginosa has been considered colonizers rather than uropathogens, but in one study, it was reported as the most common organism [14].…”

“…Instillation of mucopolysaccharidases into the bladder similar to naturally acting glycosaminoglycan has also been suggested. Use of Lactobacilli vaginal pessaries has significantly reduced recurrent UTI in females by alternating the local bacterial flora [14].…”

“…Once infection is established, it is usually persistent and resistant to the antibiotics. Therefore, renal failure and septicemia are perpetual risks for all such patients [14].…”