Evaluation of cranberry supplement for reduction of urinary tract infections in individuals with neurogenic bladders secondary to spinal cord injury. A prospective, double-blinded, placebo-controlled, crossover study

OBJECTIVE: To determine the effectiveness of cranberry supplement at preventing urinary tract infections (UTIs) in persons with spinal cord injury (SCI). DESIGN: A prospective, double-blinded, placebo-controlled, crossover study. PARTICIPANTS: 21 individuals with neurogenic bladders secondary to SCI. MAIN OUTCOME MEASURES: Favorable or unfavorable response of cranberry supplement vs placebo on urinary bacterial counts and white blood cell (WBC) counts and the combination of bacterial and WBC counts. METHODS: Individuals with neurogenic bladders due to SCI were recruited and randomly assigned to standardized 400-mg cranberry tablets or placebo 3 times a day for 4 weeks. After 4 weeks and an additional 1-week "washout period," participants were crossed over to the other group. Participants were seen weekly, during which a urine analysis was obtained. UTI was defined as significant bacterial or yeast colony counts in the urine and elevated WBC counts (WBC count > or = 10 per high power field) in centrifuged urine. Participants with symptomatic infections were treated with appropriate antibiotics for 7 days and restarted on the cranberry tablet/ placebo after a 7-day washout period. Urinary pH between the cranberry and placebo groups was compared weekly. Data were analyzed using the Ezzet and Whitehead's random effect approach. RESULTS: There was no statistically significant treatment (favorable) effect for cranberry supplement beyond placebo when evaluating the 2 treatment groups for bacterial count, WBC count, or WBC and bacterial counts in combination. Urinary pH did not differ between the placebo and cranberry groups. CONCLUSION: Cranberry tablets were not found to be effective at changing urinary pH or reducing bacterial counts, urinary WBC counts, or UTIs in individuals with neurogenic bladders. Further long-term studies evaluating specific types of bladder management and UTIs will help to determine whether there is any role for the use of cranberries in individuals with neurogenic bladders.     

Significance of bacteriuria in neurogenic bladder

OBJECTIVE: To investigate the usefulness of performing routine urine cultures in veterans with spinal cord injury (SCI) who come for annual evaluation. RESEARCH DESIGN/PARTICIPANTS: This retrospective study was performed on asymptomatic patients who came for outpatient annual evaluation. The records of 89 healthy male veterans with SCI between the ages of 22 and 82 years (mean age = 50.6) were reviewed from March through October 2000. METHODS: The following information was collected: patient's name, social security numbers, age, year of injury, level of injury, American Spinal Injury Association (ASIA) classification, urinalysis including white blood cell (WBC) count and presence or absence of nitrite, urine culture results (> or <100,000 colony-forming units of uropathogens per milliliter), blood WBC count, and mode of bladder management. The data were analyzed statistically to look at the effects of age at injury, level of injury, injury category (ASIA classification), pyuria, urinary nitrite, serum WBC count, and mode of bladder control on the presence of bacteriuria. RESULTS: Results revealed that regardless of the level of injury, individuals with ASIA A injuries were at high risk of having bacteriuria with positive culture results. Patients who were nitrite positive and/or had > or =6 WBCs per high-powered field (HPF) in the urine were also at high risk for significant bacteriuria. CONCLUSION: Urinary tract infections (UTIs) in the SCI population frequently are asymptomatic, polymicrobial, caused by antibiotic-resistant bacteria, and very likely to recur or relapse. However, there are no data to support or justify treatment of asymptomatic bacteriuria. The present study suggests that healthy asymptomatic patients with SCI who come for annual evaluations should not have routine urine cultures if they are at low risk for UTIs; that is, <6 WBC/HPF in the urine and/or nitrite negative.     

Abstract

Abstract

Seventy paired samples of urine, obtained by collection of a clean voided specimen and by suprapubic aspiration (SPA) of the bladder, were obtained from 43 male SCI patients who were free of indwelling catheters. The relationship of the presence or absence of symptoms and the degree of pyuria (determined quantitatively using a haemocytometer) to the presence or absence of bacteriuria (SPA specimen) was determined. Symptoms were poorly predictive of bacteriuria with concordance seen only 40% of the time. Most bacteriuric episodes (37/51–72.5%) were asymptomatic. The quantity of WBC in voided urine accurately reflected that in SPA urine (r = 0.825), indicating that urodynamics in SCI patients who received sphincterotomies are different than in normal persons. Pyuria (> 10⁴ WBC per cc urine) was an excellent predictor of UTI-37 of 38 (97.4%) had UTI. However, 40.6% of samples with WBC < 10⁴ were also culture positive. Overall, consideration of the presence or absence of pyuria in relation to the presence of bacteriuria provided a sensitivity of 74.0%, specificity of 95.9%, and predictive value of a positive test of 97.4%. The predictive value of a negative test (WBC < 10⁴), however, was only 59.4%. There was poor correlation between absolute bacterial and WBC count. The point of cutoff for bacterial count correlating with 10⁴ WBC count was not statistically significant in these patients; this is possibly due to repeated bacterial contamination from anterior urethra. While symptom status was often misleading, the presence of > 10⁴ WBC per cc of urine was highly predictive of the presence of bacteriuria in male SCI patients. As a reflection of inflammation, pyuria may further serve the purpose of distinguishing true bladder infection from simple colonization.     

Microbiology of the urethra and perineum and its relationship to bacteriuria in community-residing men with spinal cord injury

OBJECTIVE: Reasons why some persons with spinal cord injury (SCI) experience recurrent urinary tract infections more than others are poorly understood. We performed a prospective study of bacterial flora of the urethra and perineum in men with and without bacteriuria to understand more completely the relationship between bacterial colonization and invasion of the urinary tract. METHODS: Urine, urethra, and perineum cultures were obtained from 70 men. Microbial flora of these sites was compared for men with and without bacteriuria. RESULTS: Urine colony count was 0 in 16 (22.9%) men. Perinea in 2 men (12.5%) and urethras in 6 men (37.5%) were colonized with various gram-negative bacilli, enterococci, and/or Staphylococcus aureus. Among 54 (77.1%) men with bacteriuria, uropathogens were shown in the perineum in 31 (57.4%) and in the urethra in 46 (85.2%). In 40 (74.1%) of men with bacteriuria, at least one bacterial species present in the urine was also found in the urethra and/or perineum. Differences in the occurrence of uropathogens in men with and without bacteriuria were statistically significant, and organisms were present in higher numbers in men with bacteriuria. CONCLUSION: Men with SCI who have bacteriuria are significantly more likely to be colonized in the distal urethra and perineum with uropathogens that are often present in the urine in comparison with men without bacteriuria.     

Evaluation Of Cranberry Supplement For Reduction Of Urinary Tract Infections In Individuals With Neurogenic Bladders Secondary To Spinal Cord Injury.A Prospective,Double-Blinded,Placebo–Controlled,Crossover Study

Abstract

Objective: To determine the effectiveness of cranberry supplement at preventing urinary tract infections (UTis) in persans with spinal cord injury (SCI).

Design: A prospective, double–blinded, placebo–controlled, crossover study.

Participants: 21 individuals with neuragenie bladders secondary to SCI. Main Outcome Measures: Favorable or unfavorable response of cranberry supplement vs placebo on urinary bacterial counts and white blood cell (WBC) counts and the combination of bacterial and WBC counts.

Methods: lndividuals with neuragenie bladders due to SCI were recruited and randomly assigned to standardized 400–mg cranberry tablets or placebo 3 times a day for 4 weeks. After 4 weeks and an additional 1–week “washout period,” participants were crossed over to the other group. Participants were seen weekly, during which a urine analysis was obtained. UTI was defined as significant bacterial or yeast colony counts in the urine and elevated WBC counts (WBC count 2: 1 0 perhigh power field) in centrifuged urine. Participa nts with symptomatic infections were treated with appropriate antibiotics for 7 days and restarted on the cranberry tablet/ placebo after a 7–day washaut period. Urinary pH between the cranberry and placebo groups was compared weekly. Data were analyzed using the Ezzet and Whitehead’s random effect approach.

Results: There was no statistically significant treatment (favorable) effect for cranberry supplement beyond placebo when evaluating the 2 treatment groups for bacterial count, WBC count, or WBC and bacterial counts in combination. Urinary pH did not differ between the placebo and cranberry groups.

Conclusion: Cranberry tablets were not found to be effective at changing urinary pH or reducing bacterial counts, urinary WBC counts, or UTis in individuals with neuragenie bladders. Further Long–term studies evaluating specific types of bladder management and UTis will help to determine whether there is any role for the use of cranberries in individuals with neuragenie bladders.     

Effects of the routine change of chronic indwelling Foley catheters in persons with spinal cord injury

OBJECTIVE: To determine whether routine catheter changes have any effect on the urinary white blood cell count (WBC) and bacterial culture in asymptomatic individuals with spinal cord injury (SCI) who have indwelling Foley catheters. DESIGN: Prospective case series. SETTING: Urology and SCI outpatient departments of a rehabilitation center. SUBJECTS: Twelve asymptomatic individuals (male and female) with SCI who have chronic indwelling urethral Foley catheters that are changed routinely every month. MAIN OUTCOME MEASURES: Two sets of urinalysis and urinary culture and sensitivity from each individual, one set taken through the Foley catheter before the catheter change and another set after the catheter change. WBC, bacterial identity, and colony count were measured, and the corresponding data were compared. RESULTS: All subjects had pyuria and bacteriuria before and after the catheter change. Analysis of the data showed a statistically significant increase in WBC in the urine after the indwelling Foley catheter was changed (P = .0039). However, bacterial types and corresponding colony counts remained almost completely unchanged. CONCLUSIONS: Routine change of chronic indwelling Foley catheters in asymptomatic individuals with SCI causes a significant rise in the urinary WBC, without altering the bacterial identity or colony count. Pyuria and bacteriuria are prevalent among individuals with SCI (including those who are asymptomatic) with indwelling Foley catheters. This study suggests that urinalysis should be taken before a catheter change.     

Urinary tract infection in oliguric patients with chronic renal failure

We studied 182 patients with chronic renal failure by urinalysis and urine cultures. Of the patients 27 per cent had significant bacteriuria (more than 10(5) per ml.), 38 per cent had significant pyuria (more than 10 white blood cells per high power field), 19 per cent had urinary tract infection and 7 per cent had symptomatic urinary tract infection. All 12 patients with symptomatic urinary tract infection had significant bacteriuria and 11 had significant pyuria, while 1 had 5 to 10 white blood cells per high power field. Incidences of urinary tract infection differed depending on the primary renal disease (12, 13, 41 and 67 per cent for chronic glomerulonephritis, diabetic nephropathy, polycystic kidney and chronic pyelonephritis, respectively). Among the patients with chronic glomerulonephritis no significant differences were seen in frequencies of bacteriuria and urinary tract infection between male and female patients or between those who did and did not undergo hemodialysis. Also, no significant correlation was seen between bacteriuria and daily urine output but pyuria was significantly more frequent in oliguric patients or those on hemodialysis.     

Incidence of urinary tract infection following initiation of intermittent catheterization among patients with recent spinal cord injury in Germany and the Netherlands

Objective: To assess incidence of urinary tract infection (UTI) among patients with recent spinal cord injury (SCI) who initiated intermittent catheterization (IC).Design: Retrospective chart review.Setting: Two European SCI rehabilitation centers.Participants: Seventy-three consecutive patients with recent SCI who initiated IC.Outcome measures: Incidence of UTI, using six different definitions, each based on microbiology ± symptomatology ± mention of UTI . Rates were expressed in terms of numbers of UTIs per 100 patient-months (PMs). Attention was focused on first-noted UTI during the three-month follow-up, as assessed with each of the six definitions.Results: Fifty-eight percent of patients (n = 33) met ≥1 definitions for UTI during follow-up (rate: 31.5 UTIs per 100 PMs), ranging from 14% (5.3 per 100 PMs; definition requiring bacteriuria, pyuria, and presence of symptoms) to 45% (22.7 per 100 PMs; definition requiring “mention of UTI”). Ten cases were identified using the definition that required bacteriuria, pyuria, and symptoms, whereas definitions that required bacteriuria and either pyuria or symptoms resulted in the identification of 20–25 cases. Median time to UTI ranged from 42 days (“mention of UTI”) to 81 days (definition requiring bacteriuria and ≥100 leukocytes/mm³).Conclusion: Depending on definition, 14% to 45% of patients with recent SCI experience UTI within three months of initiating IC. Definitions requiring bacteriuria and either pyuria or symptoms consistently identified about twice as many cases as those that required all three conditions. Standardizing definitions may help improve detection, treatment, and prevention of UTI within this vulnerable population.     

Accuracy of individuals with spinal cord injury at predicting urinary tract infections based on their symptoms

OBJECTIVE: To determine whether individuals with spinal cord injuries (SCIs) who complain of symptoms of a urinary tract infection (UTI) actually have a UTI. DESIGN: A 9-month prospective case review. PARTICIPANTS: One hundred and forty-seven persons with SCI who presented to an outpatient urology clinic with symptoms they attributed to a UTI. MAIN OUTCOME MEASURES: Presence or absence of a UTI as determined by signs and symptoms of a UTI and a microscopic urine analysis (UA) for white blood cell (WBC) and bacterial colony counts. METHODS: A UTI was defined as new onset of clinical signs and symptoms, significant bacterial colony counts in the urine, and evidence of tissue invasion with elevated WBC count > or = 10/high power field in the urine. Evaluation of each individual included history, physical examination, and UA with a culture and sensitivity. Evaluation for other medical problems was undertaken if history, physical examination, and laboratory results were not consistent with a UTI. RESULTS: Sixty-one percent (90/147) of SCI persons were accurate in predicting the presence of a UTI based on their symptoms; 39% (57/147) were not accurate. In the group of 57 persons who were not accurate in predicting whether they had a UTI, 12 persons had other medical problems including fecal impaction, bowel obstruction, dehydration, heat intolerance, glucosuria, other infectious processes, respiratory problems, and neurologic problems. The remaining 45 had bacteriuria with no pyuria. The type of bladder management did not have an impact on the accuracy of predicting the presence or absence of a UTI (P = 0.03). CONCLUSION: Individuals with SCI were frequently not accurate at predicting whether they had a UTI based on their symptoms.     

Perioperative lower urinary tract infections and deep sepsis in patients undergoing total joint arthroplasty

Deep sepsis in the involved joint after hip or knee arthroplasty may be the result of hematogenous seeding from a remote infectious source. This mechanism has been used to explain the well-documented association between postoperative urinary tract infections and subsequent joint infection after hip or knee arthroplasty. However, it is unclear whether there is an association between preoperative bacteriuria and deep prosthetic infection. The purpose of this review is to identify perioperative risk factors associated with bacteriuria that have a positive correlation with deep joint sepsis following total hip or knee arthroplasty. The classic symptoms of dysuria, urgency, and frequency seen with urinary tract infections are often absent in the elderly despite the presence of urine coliforms; in these patients, pyuria (as indicated by the presence of more than 1x10(3) white blood cells per milliliter of noncentrifuged urine) may be used as a preliminary screening criterion. If there are irritative symptoms, the presence of more than 1x10(3) bacteria per milliliter of urine should be regarded as indicative of a urinary tract infection. If there is bacteriuria without symptoms of urinary irritation or obstruction, the current literature supports proceeding with total joint arthroplasty and treating those patients with urine colony counts greater than 1x10(3)/mL with an 8- to 10-day postoperative course of an appropriate oral antibiotic. Postponement of total joint surgery should be considered if preoperative evaluation reveals symptoms related to obstruction of the urinary pathway. Irritative symptoms in combination with a bacterial count greater than 1x10(3)/mL should also serve as an indication to postpone surgery. To diminish postoperative urinary tract infection, a bladder catheter should be inserted immediately preoperatively and removed within 24 hours of surgery to diminish the risk of urinary retention, which has been shown to increase the likelihood of a postoperative urinary tract infection.     

Evaluation of cranberry tablets for the prevention of urinary tract infections in spinal cord injured patients with neurogenic bladder

Study Design:Randomized, double blind, placebo-controlled trial with a crossover design.Objective:To evaluate cranberry tablets for the prevention of urinary tract infection (UTI) in spinal cord injured (SCI) patients.Setting:Spinal Cord Injury Unit of a Veterans Administration Hospital, MA, USA.Methods:Subjects with spinal cord injury and documentation of neurogenic bladder were randomized to receive 6 months of cranberry extract tablet or placebo, followed by the alternate preparation for an additional 6 months. The primary outcome was the incidence of UTI.Results:Forty-seven subjects completed the trial. We found a reduction in the likelihood of UTI and symptoms for any month while receiving the cranberry tablet (P<0.05 for all). During the cranberry period, 6 subjects had 7 UTI, compared with 16 subjects and 21 UTI in the placebo period (P<0.05 for both number of subjects and incidence). The frequency of UTI was reduced to 0.3 UTI per year vs 1.0 UTI per year while receiving placebo. Subjects with a glomerular filtration rate (GFR) greater than 75 ml min(-1) received the most benefit.Conclusion:Cranberry extract tablets should be considered for the prevention of UTI in SCI patients with neurogenic bladder. Patients with a high GFR may receive the most benefit.Sponsorship:Spinal Cord Research Foundation, sponsored by the Paralyzed Veterans of AmericaSpinal Cord (2008) 46, 622-626; doi:10.1038/sc.2008.25; published online 8 April 2008.     

Reduction of Escherichia coli adherence to uroepithelial bladder cells after consumption of cranberry juice: a double-blind randomized placebo-controlled cross-over trial

To determine the efficacy of the consumption of cranberry juice versus placebo with regard to the presence of in vitro bacterial anti-adherence activity in the urine of healthy volunteers. Twenty healthy volunteers, 10 men and 10 women, were included. The study was a double-blind, randomized, placebo-controlled, and cross-over study. In addition to normal diet, each volunteer received at dinner a single dose of 750 ml of a total drink composed of: (1) 250 ml of the placebo and 500 ml of mineral water, or (2) 750 ml of the placebo, or (3) 250 ml of the cranberry juice and 500 ml of mineral water, or (4) 750 ml of the cranberry juice. Each volunteer took the four regimens successively in a randomly order, with a washout period of at least 6 days between every change in regimen. The first urine of the morning following cranberry or placebo consumption was collected and used to support bacterial growth. Six uropathogenic Escherichia coli strains (all expressing type 1 pili; three positive for the gene marker for P-fimbriae papC and three negative for papC), previously isolated from patients with symptomatic urinary tract infections, were grown in urine samples and tested for their ability to adhere to the T24 bladder cell line in vitro. There were no significant differences in the pH or specific gravity between the urine samples collected after cranberry or placebo consumption. We observed a dose dependent significant decrease in bacterial adherence associated with cranberry consumption. Adherence inhibition was observed independently from the presence of genes encoding type P pili and antibiotic resistance phenotypes. Cranberry juice consumption provides significant anti-adherence activity against different E. coli uropathogenic strains in the urine compared with placebo.     

Evaluation of 3 methods of bladder irrigation to treat bacteriuria in persons with neurogenic bladder

BACKGROUND/OBJECTIVE: We conducted a randomized, double-blind comparison of twice daily bladder irrigation using 1 of 3 different solutions in community-residing persons with neurogenic bladder who used indwelling catheters to evaluate efficacy in treatment of bacteriuria. METHODS: Eighty-nine persons with bacteriuria were randomized to irrigate their bladders twice daily for 8 weeks with 30 mL of (a) sterile saline, (b) acetic acid, or (c) neomycin-polymyxin solution. Urinalysis, cultures, and antimicrobial susceptibility tests were performed at baseline and weeks 2, 4, and 8 to determine the extent to which each of the solutions affected numbers and types of bacteria, urinary pH, urinary leukocytes, and generation of antimicrobial-resistant organisms. RESULTS: Bladder irrigation was well tolerated with the exception of 3 participants who had bladder spasms. None of the 3 irrigants had a detectable effect on the degree of bacteriuria or pyuria in 52 persons who completed the study protocol. A significant increase in urinary pH occurred in all 3 groups. No significant development of resistance to oral antimicrobials beyond what was observed at baseline was detected. CONCLUSIONS: Bladder irrigation was generally well tolerated for 8 weeks. No advantages were detected for neomycin-polymyxin or acetic acid over saline in terms of reducing the urinary bacterial load and inflammation. We cannot recommend bladder irrigation as a means of treatment for bacteriuria in persons with neurogenic bladder.     

Microbiology Of The Urethra and Perineum and Its Relationship To Bacteriuria In Community-Residing Men With Spinal Cord Injury

Abstract

Objective: Reasons why some persans with spinal cord injury (SCI) experience recurrent urinary tract infections more than others are poorly understood. We performed a prospective study of bacterial flora of the urethra and perineum in men with and without bacteriuria to understand more completely the relationship between bacterial colonization and invasion of the urinary tract.

Methods: Urine, urethra, and perineum cultures were obtained from 70 men. Microbial flora of these sites was compared formen with and without bacteriuria.

Results: Urine colony countwas 0 in 1 6 (22 .9%) men. Perinea in 2 men (1 2.5%) and urethras in 6 men (3 7.5%) were colonized with various gram-negative bacilli, enterococci, and/ or Staphylococcus aureus. Among 54 (77.1 %) men with bacteriuria, uropathogens were shown in the perineum in 31 (5 7.4%) andin the urethra in 46 (85 .2%) . ln 40 (7 4.1 %) of men with bacteriuria, at least one bacterial species present in the urinewas also found in the urethra and/ or perineum. Differences in the occurrence of uropathogens in men with and without bacteriuria were statistically significant, and organisms were present in higher numbers in men with bacteriuria.

Conclusion: Men with SCI who have bacteriuria are significantly more likely to be colonized in the distal urethra and perineum with uropathogens that are often present in the urine in comparison with men without bacteriuria.     

Evaluation of 3 Methods of Bladder Irrigation to Treat Bacteriuria in Persons With Neurogenic Bladder

Abstract

Background/Objective: We conducted a randomized, double-blind comparison of twice daily bladder irrigation using 1 of 3 different solutions in community-residing persons with neurogenic bladder who used indwelling catheters to evaluate efficacy in treatment of bacteriuria.

Methods: Eighty-nine persons with bacteriuria were randomized to irrigate their bladders twice daily for 8 weeks with 30 mL of (a) sterile saline, (b) acetic acid, or (c) neomycin-polymyxin solution. Urinalysis, cultures, and antimicrobial susceptibility tests were performed at baseline and weeks 2, 4, and 8 to determine the extent to which each of the solutions affected numbers and types of bacteria, urinary pH, urinary leukocytes, and generation of antimicrobial-resistant organisms.

Results: Bladder irrigation was well tolerated with the exception of 3 participants who had bladder spasms. None of the 3 irrigants had a detectable effect on the degree of bacteriuria or pyuria in 52 persons who completed the study protocol. A significant increase in urinary pH occurred in all 3 groups. No significant development of resistance to oral antimicrobials beyond what was observed at baseline was detected.

Conclusions: Bladder irrigation was generally well tolerated for 8 weeks. No advantages were detected for neomycin-polymyxin or acetic acid over saline in terms of reducing the urinary bacterial load and inflammation. We cannot recommend bladder irrigation as a means of treatment for bacteriuria in persons with neurogenic bladder.     

Effects of The Routine Change of Chronic Indwelling Foley Catheters In Persons with Spinal Cord Injury

Abstract

Objective: To determine whether routine catheter changes have any effect on the urinary white blood cell count (WBC) and bacterial culture in asymptomatic individuals with spinal cord injury (SCI) who have indwelling Foley catheters.

Design: Prospective case series.

Setti11g: Urology and SCI outpatient departments of a rehabilitation center.

Subjects: Twelve asymptomatic individuals (male and female) with SCI who have chronic indwelling urethral Foley catheters that are changed routinely every month.

Main Outcome Measures: Two sets of urinalysis and urinary culture and sensitivity from each individual, one set taken through the Foley catheter before the catheter change and another set after the catheter change. WBC, bacterial identity, and colony count were measured, and the corresponding data were compared.

Results: All subjects had pyuria and bacteriuria before and after the catheter change. Analysis of the data showed a statistically significant increase in WBC in the urine after the indwelling Foley catheter was changed (P = .0039). However; bacterial types and corresponding colony counts remained almost completely unchanged.

Conclusions: Routine change of chronic indwelling Foley catheters in asymptomatic individuals with SCI causes a significant rise in the urinary WBC, without altering the bacterial identity or colony count. Pyuria and bacteriuria are prevalent among individuals with SCI (including those who are asymptomatic) with indwelling Foley catheters. This study suggests that urinalysis should be taken before a catheter change.     

Accuracy Of Individuals With Spinal Cord Injury At Predicting Urinary Tract Infections Based On Their Symptoms

Abstract

Objective: To determine whether individuals with spinal cord injuries (SCis) who complain of symptoms of a urinary tract infection (UTI) actually have a UTI.

Design: A 9-month prospective case review.

Participants: One hundred and forty-seven persons with SCI who presented to an outpatient urology clinic with symptoms they attributed to a UTI.

Main Outcome Measures: Presence or absence of a UTI as determined by signs and symptoms of a UTI and a microscopic urine analysis (UA) for white blood cell (WBC) and bacterial colony counts.

Methods: A UTI was defined as new onset of clinical signs and symptoms, significant bacterial colony counts in the urine, and evidence of tissue invasion with elevated WBC count 2:10/ high power field in the urine. Evaluation of each individual included history, physical examination, and UA with a culture and sensitivity. Evaluation for other medical problems was undertaken if history, physical examination, and laboratory results were not consistent with a UTI.

Results: Sixty-one percent (90/147) of SCI persons we re accurate in predicting the presence of a UTI based on their symptoms; 39% (57 /147) were not accurate. In the group of 57 pe rsons who were not accurate in predicting whether they had a UTI, 12 persons had other medical problems including fecal impaction, bowel obstruction, dehydration, heat intolerance, glucosuria, other infectious processes, respiratory problems, and neurologic problems. The remaining 45 had bacteriuria with no pyuria. The type of bladder management did not have an impact on the accuracy of predicting the presence or absence of a UTI (P = 0 .03).     

Nitrite and leukocyte dipstick testing for urinary tract infection in individuals with spinal cord injury

OBJECTIVE: To determine sensitivity, specificity, and positive and negative predictive values of nitrite (NIT) and leukocyte esterase (LE) testing in relation to laboratory evidence of significant bacteriuria and urinary tract infection (UTI) in persons with spinal cord injury (SCI). DESIGN: Monthly urine cultures were compared with results of dipstick testing. SETTING: Community based. METHODS: Fifty-six people with SCI were evaluated on a monthly basis with dipstick testing for NIT and LE as well as urine cultures. Participants reported whether they believed that they had a UTI and, if so, whether they were treated for the UTI and what symptoms they had experienced. RESULTS: The sensitivity rate for the most comprehensive criteria--defined as positive NIT test, a positive LE positive, or both a positive NIT test and positive LE test--was 0.64 and the specificity rate was only 0.52. No single type of bacteria was found to occur in more than 30% of the urine samples. CONCLUSION: Reliance on dipstick testing for NIT and LE in individuals with SCI can lead to high rates of overtreatment for UTI, given the fact that regular catheterization is associated with significant bacteriuria. Individuals with SCI should be evaluated with urine culture to ensure proper treatment.     

Bacteriuria during closed urinary drainage: an evaluation of top-vented versus bag-vented systems.

For a 10-month period a top-vented closed urinary drainage system was evaluted and compared to a conventional bag-vented drainage system. The study involved random assignment of either system to all adult patients who required urinary catheterization. Criteria for exclusion included acute or chronic genitourinary tract infection and surgical interference with bladder function. The end point of the study was removal of any part of the system after at least 24 hours or a positive urine culture (greater than 10,000 colonies per ml. urine). The series included 236 patients. Distributions of patient age, sex and hospital service assignment (medical or surgical), antibiotic usage and duration of catheterization were similar in both study groups. Of 113 patients with the top-vented system 16 (14.2 per cent) acquired bacteriuria, whereas 13 of 123 (10.6 per cent) with the bag-drainage system acquired bacteriuria. No significant difference was noted. Antibiotics were used in 202 of 236 patients (86 per cent). Although usage delayed the appearance of bacteriuria in both groups isolates were more frequently yeasts and gram-negative organisms other than Escherichia coli.     

Proteus bacteriuria is associated with significant morbidity in spinal cord injury

STUDY DESIGN: Retrospective chart review. OBJECTIVES: We investigated the morbidity associated with Proteus bacteriuria in a spinal cord injured (SCI) population. SETTING: Michael E DeBakey Veterans Affairs Medical Center in Houston, Texas, USA. METHODS: We reviewed the medical records of all veterans with SCI who received care in our medical center during the past 3 years. Proteus bacteriuria was defined as the growth of Proteus species in any urine culture during the study period. Urinary stones were defined as either renal or bladder calculi. RESULTS: During the study period, 71 of the 501 subjects (14%) had Proteus and 90 (18%) had urinary stones. Twenty-seven percent of the subjects with Proteus had stones, and the association of Proteus with stones was significant (P<0.05). Proteus bacteriuria was likewise associated with complete injury, hospitalization, decubitus ulcers, and history of stones (P<0.001). Subjects using indwelling catheters, either transurethral or suprapubic, were significantly more likely to have Proteus, whereas subjects practising spontaneous voiding and clean intermittent catheterization were significantly less likely to have Proteus. In the 90 patients with stones, Proteus was associated with requiring treatment for stones and having multiple stones (P<0.01). Twenty-five of the 90 patients with stones (28%) required treatment, most often with lithotripsy, and 6 (7%) developed urosepsis. CONCLUSIONS: In persons with SCI, Proteus was found in subjects with a greater degree of impairment who were more likely to be hospitalized, to have decubiti, and to use indwelling catheters. Bacteriuria with Proteus predicted urologic complications in persons with SCI. STATEMENT OF ETHICS: All applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research.