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Risk factors for febrile genito-urinary infection in the catheterized patients by with spinal cord injury-associated chronic neurogenic lower urinary tract dysfunction evaluated by urodynamic study and cystography: a retrospective study

  • Katsumi ShigemuraEmail author
  • Koichi Kitagawa
  • Masashi Nomi
  • Akihiro Yanagiuchi
  • Atsushi Sengoku
  • Masato Fujisawa
Original Article

Abstract

Introduction

To investigate the risk factors for febrile genito-urinary tract infection (GUTI) in spinal cord injury-associated neurogenic lower urinary tract dysfunction (NLUTD) patients who perform routine clean intermittent catheterization (CIC) evaluated by urodynamic study (UDS) and cystography.

Patients and methods

Over a 3-year period, we retrospectively assessed risk factors for febrile UTI in 141 spinal cord injury patients diagnosed as NLUTD and performing routine CIC, regarding gender, UDS findings such as bladder compliance, maximum cystometric capacity, and cystography.

Results

A total of 41 patients had febrile GUTI in the follow-up period as along with 32 cases of pyelonephritis, 10 cases of epididymitis, and 1 case of prostatitis, including patients with multiple infectious diseases. The causative bacteria were Escherichia coli (14 cases) followed by Pseudomonas aeruginosa (n = 5), Klebsiella pneumoniae (n = 4), and Klebsiella oxytoca (n = 4). Antibiotic-resistant E. coli were seen, with 36.4% instances of extended-spectrum beta-lactamase production in whole of E. coli. Male gender (p = 0.018), ASIA Impairment Scale (AIS) C or more severe (p = 0.031), the number of CIC (p = 0.034), use of quinolones (p < 0.001) and severe bladder deformity (DG 2 or more, p = 0.004) were significantly associated with febrile GUTI occurrence.

Conclusions

Our data demonstrated that male gender, severe bladder deformity (DG 2 or more), AIS C or more, the number of CIC, and use of quinolones were significantly associated with febrile GUTI occurrence in NLUTD patients employing routine CIC. Further prospective studies are necessary to define the full spectrum of possible risk factors for febrile GUTI in these patients.

Keywords

Spinal cord injury Urinary tract infection Neurogenic lower urinary tract dysfunction Clean intermittent catheterization Urodynamic study Cystography 

Notes

Author contributions

KS: data collection, data analysis and writing the manuscript. KK: data analysis. MN: data collection. AY: data analysis, AS: management of patients and manuscript editing. MF: manuscript editing

Funding

There is no external funding for this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study formal consent is not required.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Urology, Department of SurgeryKobe University Graduate School of MedicineKobeJapan
  2. 2.Department of Infection Control and PreventionKobe University HospitalKobeJapan
  3. 3.Division of Advanced Medical ScienceKobe University Graduate School of Science, Technology and InnovationKobeJapan
  4. 4.Department of UrologyHyogo Prefectural Central Rehabilitation HospitalHyogoJapan
  5. 5.Department of UrologyHyogo Prefectural Nishi-Harima Rehabilitation HospitalHyogoJapan

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