Uropathogens and empiric antibiotics for the treatment of urinary tract infections in spinal cord injured patients at rehabilitation center, Thai Red Cross Society during 2001 to 2005 (original) (raw)
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Journal of the Medical Association of Thailand = Chotmaihet thangphaet
Urinary tract infection (UTI) is common in spinal cord injured patients. The authors investigated the epidemiology of bacteria associated with UTI to select an appropriate antibiotic for empirical treatment of UTI before obtaining a bacterial culture. To determine the prevalence, as well as the causative bacteria and their susceptibility pattern of urinary tract infection in spinal cord injured patients hospitalized to the Rehabilitation Center, Thai Red Cross Society, Samutprakarn, Thailand from January 2001 to December 2005. A retrospective chart review of 76 spinal cord injured patients. Of all spinal cord injured patients, there were 50 males and 26 females, with the average age of 44.70 years. The average length of hospitalization was 104.5 days. 71.2% of the patients needed intermittent catheterization for bladder drainage, and only 2.7% had suprapubic cystostomy. None of patient had indwelling catheterization. Forty-six patients had 68 episodes of UTI (60.52%). Eighteen patie...
Jundishapur Journal of Microbiology, 2014
Background: Urinary tract infections (UTIs) are important causes of morbidity and mortality in patients with spinal cord injury and 22% of patients with acute spinal cord injury develop UTI during the first 50 days. Objectives: The aim of this study was to determine the prevalence, etiologic agents and risk factors for asymptomatic bacteriuria and symptomatic urinary tract infections in patients with spinal cord injury. Patients and Methods: This was a prospective investigation of spinal cord injury patients with asymptomatic bacteriuria and symptomatic urinary tract infections in Baskent University Medical Faculty Ayas Rehabilitation Center and Ankara Physical Therapy and Rehabilitation Center between January 2008 and December 2010. The demographic status, clinical and laboratory findings of 93 patients with spinal cord injury were analyzed in order to determine the risk factors for asymptomatic or symptomatic bacteriuria Results: Sixty three (67.7%) of 93 patients had asymptomatic bacteriuria and 21 (22.6%) had symptomatic urinary tract infection. Assessment of the frequency of urinary bladder emptying methods revealed that 57 (61.3%) of 93 patients employed permanent catheters and 24 (25.8%) employed clean intermittent catheterization. One hundred and thirty-five (48.0%) of 281 strains isolated form asymptomatic bacteriuria attacks and 16 (66.6%) of 24 strains isolated from symptomatic urinary tract infection attacks, totaling 151 strains, had multidrug resistance (P > 0.05). One hundred (70.4%) of 142 Escherichia coli strains and 19 (34.5%) of 55 Klebsiella spp strains proliferated in patients with asymptomatic bacteriuria; 8 (80%) of 10 E. coli strains and 4 (80%) of 5 Klebsiella spp. strains were multidrug resistant. Conclusions: The most common infectious episode among spinal cord injury patients was found to be urinary tract ınfection. E. coli was the most common microorganism isolated from urine samples. Antibiotic use in the previous 2 weeks or 3 months, hospitalization during the last one-year and previous diagnosis of urinary tract ınfection were the risk factors identified for the development of infections with multi-drug resistant isolates. Urinary catheterization was found to be the only independent risk factor contributing to symptomatic urinary tract infection.
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To determine the frequency of urinary tract infection and commonest causative organisms in spinal cord injury patients with various modes of voiding in rehabilitation setup in Pakistan. Study Design: A descriptive study of 100 spinal cord injury patients. Place and Duration of the Study: The Armed Forces Institute of Rehabilitation Medicine (AFIRM) Rawalpindi from September 2007 to March 2008 on clinical samples received from admitted patients in CMH Rawalpindi and AFIRM. Material and Methods: In 100 patients of spinal cord urine samples were subjected to Urine Routine examination and Urine Culture sensitivity. Urine culture revealing a bacterial colony count of 105 cfu/ml or higher were considered positive for urinary tract infection (UTI) if present with symptoms. Significant bacteriuria was investigated for spectrum and sensitivity pattern as well. Results: Of all 100 spinal cord patients 52 patients (52%) had symptoms suggestive of UTI but only 37 patients (37%) had significant bacteriuria on urine culture supported by high level pyuria were declared to have UTI. E-coli was the most commonly isolated organism with total no of 20 cases (54.1%) followed by Pseudomonas 6 cases (16.2%), Klebsiella pneumoniae 3 cases (8.1%), Proteus mirabilis 3 cases (8.1%), Citrobacter freundi 2 cases (5.4%) and the least frequent was Morganella morganii with 1 case (2.7%). UTI was most frequent in patients with indwelling catheter and was least associated with self voiding. Conclusion: Urinary Tract Infection was commonly observed among spinal cord injury patients. E-coli was the commonest isolated pathogen followed by Pseudomonas, Klebsiella pneumoniae, Proteus mirabilis, Citrobacter freundi, Candida and Morganella morganii in descending order of frequency. UTI was most frequent in patients using indwelling catheter as a mode of voiding.
Urinary infections in patients with spinal cord injury
Spinal Cord, 2003
Study design: A retrospective study concerning urinary tract infections in spinal cord injury (SCI) patients. Objectives: To check whether the regular (1/week) urine cultures allow a more accurate treatment of urinary tract infections in SCI patients compared to empiric treatment. Setting: Ghent University Hospital, East-Flanders, Belgium. Methods: Group 1: 24 tetraplegic patients; group 2: 22 paraplegic patients; group 3: 28 other polytrauma patients as controls. These groups were chosen as catheterisation and other voiding methods differ according to the underlying pathology. Results: An average of four clinically significant episodes of bacteriuria were found for groups 1 and 2, while group 3 experienced very few urinary infections. The mean species turnover of the first two groups was 2. No statistically significant difference was found in antibiotic-resistance patterns of organisms isolated. Conclusion: Despite different catheterisation techniques in para-and tetraplegic patients, we conclude that: (1) the number of episodes of clinical significant nosocomial urinary infections is not different; (2) the mean species turnover is the same; (3) because of the species turnover, the value of regular urine cultures for 'documented' treatment of clinical relevant urinary infections seems to be limited. So urine culture could be performed less frequently or only when therapy becomes mandatory; (4) No oral antibiotic with superior activity was found: treatment is best started empirically (after sampling for urine culture) and adjusted to the resulting antibiotic sensitivity screening.
Spinal cord, 1997
Spinal cord-injured (SCI) patients often suer from symptomatic polymicrobial urinary tract infection (UTI). The objective of this study was to evaluate the clinical outcome and costsavings associated with antibiotic therapy based on limited vs full microbiological investigation of urine cultures in adult SCI patients with symptomatic polymicrobial UTI (52 organisms growing in urine cultures). In the ®rst part of the study, a total of 40 evaluable patients were prospectively randomized in a single-blinded fashion to receive antibiotic therapy based on either limited (21 patients) or full microbiologic investigation (19 patients) of urine cultures. The practicality of a limited microbiological investigation was further examined in the second part of the study where 12 consecutive patients with symptomatic polymicrobial UTI initially had only limited microbiological investigation of urine cultures and received antibiotic therapy accordingly. When analyzing all patients in the study, the likelihood of adequate clinical response was not signi®cantly dierent between those who received antibiotic therapy based on limited (28/33=85%) vs full (18/19=95%) microbiological investigation of urine cultures (P=0.40). An average of 183 US dollars could be saved per patient by managing symptomatic polymicrobial UTI based on a limited vs a full microbiological investigation. These results suggest that in adult SCI patients with symptomatic polymicrobial UTI antibiotic therapy guided by a limited microbiological investigation may be practical, adequate and cost-saving.
Urinary Tract Infection in Spinal Cord Injuries
Asian Journal of Pharmaceutical and Clinical Research, 2014
Objective: Spinal cord injuries are typically associated with major trauma from motor vehicle accidents, falls, sports injuries, and violence. Urinary Tract Infections (UTI) is one of the most frequent conditions seen in spinal cord injuries patients. Diagnosis is not always easy due to lack of symptoms. Present study is survey about urinary tract infection and pyuria in these patients. Methods: All of patients with spinal cord injuries, who admitted to "Brain and Spinal Injury Repair Research Centre" in Imam Hospital in duration one year, were included in this study. Clean catch midstream urine samples were collected of patients and were analyzed by biochemical and microscopically surveys. Results: In total 103 patients, 22 patients have cervical spinal cord injury, 52 patients have thoracic spinal cord injury and 13 patients have lumbar spinal cord injury. 83 patients were urine culture positive with urinary tract infection and pyuria were seen in 65 patients. the highest incidence of UTI and pyuria were demonstrated in patients with cervical spinal cord damage. E.coli, Klebsiellapneumoniea and Enterobacter cloacae were isolated in urine samples respectively. the high incidence of resistancy to Nitrofurantoin and Imipenem in E.coli were seen. Conclusion: Patients with spinal cord injuries have to use catheter for long time and or for all of life, and they are high risk to recurrent urinary tract infections and other infections. These patients need to monitor for urinary tract infection although without any symptoms of infections and sometimes they need to take prophylactic antibiotics.
Journal of Medical Science And clinical Research, 2017
Background: Symptomatic urinary tract infections are one of the common causes of morbidity in spinal cord injury patients. In hospital acquired infections, bacteria reach the bladder either through urine present in the tube or from the extension of bowel flora. The organisms like Klebsiella, Pseudomonas, etc assume increasing importance apart from E. coli. Objectives 1. To study the prevalence of micro pathogens like Klebsiella, Pseudomonas, Proteus etc. in catheter associated urinary tract infections. 2. To study sensitivity of micro pathogens to the antibiotics in patients with spinal cord injury. Materials And Methods: 100 patients with traumatic spinal cord injury are selected for this study. Blood routine, urine routine, blood urea, serum creatinine, blood sugar (fasting & postprandial) and ultrasound Kidney Ureter Bladder are done to assess the present condition and detect any complications. Urine culture and sensitivity tests are also performed and the results are analysed. Setting and design: Cross sectional study in a tertiary level multispecialty hospital. Results: The main age group affected are between 31-40 yrs. The commonest organism seen in urine culture and sensitivity are E. coli (42%), Klebsiella (28%), Pseudomonas (16%), Staphylococcus (8%), Enterococcus (6%) etc. There is increase in resistance to the drugs like ampicillin, ciprofloxacin and norfloxacin. Conclusion: It was found that, in catheter associated UTIs the prevalence of Klebsiella, Pseudomonas and staphylococcus are much more than in community acquired UTIs. Multiple drug resistance are also found to be increased.
Urinary Tract Infections in Patients with Spinal Cord Injuries
Current Infectious Disease Reports, 2011
Spinal cord injuries (SCI) result in different lower urinary tract dysfunctions. Because of both the disease and the bladder drainage method, urinary tract infections (UTIs) are one of the most frequent conditions seen in SCI patients. Diagnosis is not always easy due to lack of symptoms. Asymptomatic bacteriuria needs no treatment. If symptoms occur, antibiotherapy is indicated. Duration depends mainly on severity of illness and upper urinary tract or prostatic involvement. Choice of antibiotherapy should be based on local resistance profiles, but fluoroquinolones seems to be an adequate empirical treatment. Prevention of UTI is important, as lots of complications can be foreseen. Catheter care, permanent low bladder pressure and clean intermittent catheterization (CIC) with hydrophilic catheters are interventions that can prevent UTI. Probiotics might be useful, but data are limited.