Urinary Tract Infections after SCI

Urinary Tract Infections (UTIs) have always been a major concern for individuals with spinal cord injury (SCI). Before WW II, almost all persons with SCI died from complications related to UTI.


What are some of the causes of UTIs among individuals with SCI?

There is some controversy about the true definition of a UTI. Traditionally, a UTI was diagnosed if more than 100,000 organisms were cultured from one ml of urine (AKA >100,000 coliforms/ml or CFU). However, studies have shown acutely symptomatic infections in able-bodied (or normally healthy) patients with cultures as low as 200 CFU!

The consensus of the National Institute on Disability and Rehabilitation (NIDRR), is that the method of urine collection affects how much bacteria is significant for patients with SCI:

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When a urine sample is taken from a patient with an indwelling catheter, any bacteria detected is a significant finding for infection

Between 10 and 20% of patients who are hospitalized receive an indwelling foley catheter. Once this catheter is in place, the risk of bacteriuria is approximately 5% per day. With long-term catheterization, bacteriuria is inevitable. Catheter-associated UTIs account for 40% of all nosocomial infections and are the most common source of gram-negative bacteremia in hospitalized patients.

Signs and symptoms of a UTI involving the lower urinary tract may include:

Unless a patient has had acute retention or urologic instrumentation, fever is not likely when the lower urinary tract is involved. Since many patients with SCI have decreased or no bladder sensation, it's important to also look for other signs of a lower UTI, such as:

Patients with acute upper urinary tract involvement may present with any of the above signs and symptoms, as well as:

Those with sensation usually complain of costal vertebral angle (CVA) tenderness. In the elderly, these signs may be subtler, and may include confusion and lethargy.

UTIs are managed with a combination of antibiotics, improved bladder management and prevention methods.

There is general agreement that asymptomatic bacteriuria in a patient with an indwelling foley catheter should NOT be treated. An exception is made, however, if instrumentation is to be performed. Prophylactic antibiotics should be considered in patients with asymptomatic bacteriuria, especially when patients have reflux problems.

For patients that are mildly symptomatic, once a urine culture is obtained, oral antibiotics should be started while waiting for the results of the culture. Generally, a 7-day course is preferable. The urine culture and sensitivity ("C & S") will determine what organism is growing and what antibiotics will effectively treat it.

For patients with high fevers, dehydration, or autonomic dysreflexia, more aggressive therapy should be instituted.

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Fever (temp over 101) usually accompanies a lower urinary tract infection in patients with spinal cord injury.

Some additional points to consider:

The CDC Guideline for Prevention of Catheter-associated Urinary Tract Infections is an excellent resource.

For more information about UTIs, the American Family Physician website has an excellent resource entitled Urinary Tract Infections in Adults.

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The urine culture should be repeated if it comes back with more than two organisms.