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The effect of appropriate bladder management on urinary tract infection rate in patients with a new spinal cord injury: a prospective observational study

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Abstract

Purpose

This study aimed to determine the rate of urinary tract infection (UTI) in patients with a new spinal cord injury (SCI) and identify which bladder management technique is associated with the lowest rate of UTI.

Methods

Adults admitted to the Victorian Spinal Cord Service with a new SCI from 2012 to 2014 were enrolled. Data collected included patient characteristics, SCI level, bladder management and diagnosis of UTI. Bacteriuria (≥ 102 colony-forming organisms/mL) with clinical signs of infection was used to define a UTI.

Results

143 patients were enrolled. 36 (25%) were female; the median age was 42 years. An indwelling urethral catheter (IUC) was placed in all the patients initially. 55 (38%) patients developed a UTI with an IUC, representing a UTI rate of 8.7/1000 inpatient days. Long-term bladder management strategies were initiated after a median of 58 days. IUC removal and initiation of any other alternative bladder management halved the UTI rate to 4.4/1000 inpatient days, p < 0.001. Intermittent self-catheterisation (ISC) and suprapubic catheter placement had lower UTI rates compared to IUC, 6.84 and 3.81 UTI/1000 inpatient days, p = 0.36 and p = 0.007, respectively. An IUC was re-inserted in 29 patients and resulted in a higher UTI rate of 8.33/1000 inpatient days.

Conclusion

This study has identified a high UTI rate in new SCI patients with an IUC and reinforces the importance of early IUC removal and initiation of non-IUC bladder management in this cohort of patients.

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References

  1. Pannek J (2011) Treatment of urinary tract infection in persons with spinal cord injury: guidelines, evidence, and clinical practice. A questionnaire-based survey and review of the literature. J Spinal Cord Med 34(1):11–15

    Article  Google Scholar 

  2. Cardenas DD et al (2004) Etiology and incidence of rehospitalization after traumatic spinal cord injury: a multicenter analysis. Arch Phys Med Rehabil 85(11):1757–1763

    Article  Google Scholar 

  3. Middleton JW et al (2004) Patterns of morbidity and rehospitalisation following spinal cord injury. Spinal Cord 42(6):359–367

    Article  CAS  Google Scholar 

  4. Taweel WA, Seyam R (2015) Neurogenic bladder in spinal cord injury patients. Res Rep Urol 7:85–99

    PubMed  PubMed Central  Google Scholar 

  5. Trautner BW, Darouiche RO (2002) Prevention of urinary tract infection in patients with spinal cord injury. J Spinal Cord Med 25(4):277–283

    Article  Google Scholar 

  6. Vigil HR, Hickling DR (2016) Urinary tract infection in the neurogenic bladder. Transl Androl Urol 5(1):72–87

    PubMed  PubMed Central  Google Scholar 

  7. De Ruz AE, Leoni EG, Cabrera RH (2000) Epidemiology and risk factors for urinary tract infection in patients with spinal cord injury. J Urol 164(4):1285–1289

    Article  Google Scholar 

  8. Wyndaele JJ, De Sy WA, Claessens H (1985) Evaluation of different methods of bladder drainage used in the early care of spinal cord injury patients. Paraplegia 23(1):18–26

    CAS  PubMed  Google Scholar 

  9. McGuire EJ, Savastano J (1986) Comparative urological outcome in women with spinal cord injury. J Urol 135(4):730–731

    Article  CAS  Google Scholar 

  10. Krebs J, Wollner J, Pannek J (2016) Risk factors for symptomatic urinary tract infections in individuals with chronic neurogenic lower urinary tract dysfunction. Spinal Cord 54(9):682–686

    Article  CAS  Google Scholar 

  11. Shekelle PG et al (1999) Systematic review of risk factors for urinary tract infection in adults with spinal cord dysfunction. J Spinal Cord Med 22(4):258–272

    Article  CAS  Google Scholar 

  12. Sorokin I, De E (2015) Options for independent bladder management in patients with spinal cord injury and hand function prohibiting intermittent catheterization. Neurourol Urodyn 34(2):167–176

    Article  Google Scholar 

  13. Gribble MJ, McCallum NM, Schechter MT (1988) Evaluation of diagnostic criteria for bacteriuria in acutely spinal cord injured patients undergoing intermittent catheterization. Diagn Microbiol Infect Dis 9(4):197–206

    Article  CAS  Google Scholar 

  14. Manack A et al (2011) Epidemiology and healthcare utilization of neurogenic bladder patients in a US claims database. Neurourol Urodyn 30(3):395–401

    Article  Google Scholar 

  15. Bennett CJ et al (1997) The effect of urethral introducer tip catheters on the incidence of urinary tract infection outcomes in spinal cord injured patients. J Urol 158(2):519–521

    Article  CAS  Google Scholar 

  16. Romo PGB, Smith CP, Cox A et al (2018) Non-surgical urologic management of neurogenic bladder after spinal cord injury. World J Urol 36:1555–1568

    Article  Google Scholar 

  17. Adriaansen JJ et al (2017) Bladder-emptying methods, neurogenic lower urinary tract dysfunction and impact on quality of life in people with long-term spinal cord injury. J Spinal Cord Med 40(1):43–53

    Article  Google Scholar 

  18. Erickson RP et al (1982) Bacteriuria during follow-up in patients with spinal cord injury: I. Rates of bacteriuria in various bladder-emptying methods. Arch Phys Med Rehabil 63(9):409–412

    CAS  PubMed  Google Scholar 

  19. Dahlberg A et al (2004) Bladder management in persons with spinal cord lesion. Spinal Cord 42(12):694–698

    Article  CAS  Google Scholar 

  20. Weld KJ, Dmochowski RR (2000) Effect of bladder management on urological complications in spinal cord injured patients. J Urol 163(3):768–772

    Article  CAS  Google Scholar 

  21. Afsar SI et al (2013) Compliance with clean intermittent catheterization in spinal cord injury patients: a long-term follow-up study. Spinal Cord 51(8):645–649

    Article  CAS  Google Scholar 

  22. Feneley RC, Hopley IB, Wells PN (2015) Urinary catheters: history, current status, adverse events and research agenda. J Med Eng Technol 39(8):459–470

    Article  Google Scholar 

  23. Mitsui T et al (2000) Is suprapubic cystostomy an optimal urinary management in high quadriplegics? A comparative study of suprapubic cystostomy and clean intermittent catheterization. Eur Urol 38(4):434–438

    Article  CAS  Google Scholar 

  24. Sheriff MK et al (1998) Long-term suprapubic catheterisation: clinical outcome and satisfaction survey. Spinal Cord 36(3):171–176

    Article  CAS  Google Scholar 

  25. Tambyah PA, Halvorson KT, Maki DG (1999) A prospective study of pathogenesis of catheter-associated urinary tract infections. Mayo Clin Proc 74(2):131–136

    Article  CAS  Google Scholar 

  26. Saint S, Chenoweth CE (2003) Biofilms and catheter-associated urinary tract infections. Infect Dis Clin N Am 17(2):411–432

    Article  Google Scholar 

  27. Shrier I, Platt RW (2008) Reducing bias through directed acyclic graphs. BMC Med Res Methodol 8:70

    Article  Google Scholar 

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Funding

This study was funded by a Grant from the Institute for Safety, Compensation and Recovery Research (ISCRR).

Author information

Authors and Affiliations

  1. Victorian Spinal Cord Service, Austin Health, Heidelberg, Vic, Australia

    L. MacLellan, C. E. Byrne & A. K. Nunn

  2. Department of Urology, Austin Health, University of Melbourne, Melbourne, Australia

    Derek B. Hennessey, N. Kinnear & J. Gani

  3. Department of Urology, Western Health, University of Melbourne, Melbourne, Australia

    J. Gani

Authors
  1. Derek B. Hennessey
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  2. N. Kinnear
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  3. L. MacLellan
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  4. C. E. Byrne
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  5. J. Gani
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  6. A. K. Nunn
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Contributions

DH wrote the paper and did the statistical analysis. NK helped to write the paper and did the statistical analysis. LM did data collection and statistical analysis and helped to refine the final manuscript. CB did data collection and helped to refine the final manuscript. JG assisted in analysis and helped to refine the final manuscript. AN created the report concept and helped to refine the final manuscript.

Corresponding author

Correspondence to Derek B. Hennessey.

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No potential conflict of interest relevant to this article was reported.

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Hennessey, D.B., Kinnear, N., MacLellan, L. et al. The effect of appropriate bladder management on urinary tract infection rate in patients with a new spinal cord injury: a prospective observational study. World J Urol 37, 2183–2188 (2019). https://doi.org/10.1007/s00345-018-02620-7

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  • DOI: https://doi.org/10.1007/s00345-018-02620-7

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