URINARY-TRACT INFECTION IN PERSONS WITH SPINAL-CORD INJURY

Persons with spinal cord injury (SCI) have an increased risk of develo ping urinary tract infections, Certain structural and physiological fa ctors, such as bladder over-distention, vesicoureteral reflux, high-pr essure voiding, large post-void residuals, stones in the urinary tract , and outlet obstruction increase the risk of infection, The method of bladder drainage also influences the risk of urinary tract infection, and most persons with SCI on indwelling or intermittent catheterizati on develop urinary tract infection, The association of behavioral and demographic factors with the risk of urinary tract infection are less well understood, The method of specimen collection must be considered when determining the significance of bacteria, A national consensus co nference sponsored by the National Institute on Disability and Rehabil itation Research defined significant bacteriuria as: greater than or e qual to 10(2) colony forming units (cfu) of uropathogens per millilite r of urine in catheter specimens from persons on intermittent catheter ization; greater than or equal to 10(4) cfu/mL in clean-voided specime ns from catheter-free males using condom catheters; and any detectable concentration of uropathogens in indwelling catheter or suprapubic as pirate specimens, Symptomatic urinary tract infection warrants therapy , but the diagnosis is complicated by the poor sensitivity and specifi city of symptoms and signs, Pyuria is generally present in persons wit h symptomatic urinary tract infection, although it is a nonspecific te st, and its absence generally indicates the absence of symptomatic uri nary tract infection, Treatment of asymptomatic bacteriuria has not be en shown to be beneficial and increases the risk of development of ant imicrobial-resistant uropathogens, Antibiotic prophylaxis is generally not recommended because of its unproven benefit in several studies an d its association with emergence of antimicrobial resistance. A patien t/physician partnership is important in planning the diagnostic evalua tions, treatment, and long-term management of urinary tract infection in persons with SCI.