Eradication of urinary tract infection following spinal cord injury

Abstract

A prospective study to evaluate the microbiological efficacy of antimicrobial treatment for urinary tract infection (UTI) was performed in 64 catheter-free spinal cord injured (SCI) patients who were visited monthly by a public health nurse who collected urine for culture and urinalysis. Patients also mailed urine dip slides for weekly bacterial counts. UTI was defined as a culture yielding ≥ 100,000 colonies/ml. Treatment was given to asymptomatic patients only if pyuria (≥10 urinary leukocytes/high powered microscopic field) was present. Initial treatment was for 7–14 days (group 1). When it became apparent during the study that eradication was difficult and relapse or reinfection frequently occurred within a short time after cessation of antibiotic, a second treatment course of ≥ 28 days (group 2) was given. By the end of the study, in which all patients were followed for a minimum of 30 days post treatment, 39/42 (93%) cases in group 1 and 11/13 (85%) in group 2 who had initial eradication, had relapsed or become reinfected. The median number of days and standard error for group 1 to relapse or become reinfected was 16 ± 2.5, and for group 2 it was 27 ± 6. Development of drug resistance was documented when bacteria isolated prior to any treatment were compared with strains isolated after ≥ 28 days of antibiotics. In this study, urine sterility was achieved in a minority of treated UTIs and was relatively short lived. Advisability of treating asymptomatic UTI following SCI is questionable from both a medical-economic and microbiologic standpoint, particularly in view of the likelihood of inducing multidrug resistance with prolonged antibiotic exposure.