ERADICATION OF URINARY-TRACT INFECTION FOLLOWING SPINAL-CORD INJURY

A prospective study to evaluate the microbiological efficacy of antimi crobial treatment for urinary tract infection (UTI) was performed in 6 4 catheter-free spinal cord injured (SCI) patients who were visited mo nthly by a public health nurse who collected urine for culture and uri nalysis. Patients also mailed urine dip slides for weekly bacterial co unts. UTI was defined as a culture yielding greater-than-or-equal-to 1 00,000 colonies/ml. Treatment was given to asymptomatic patients only if pyuria (greater-than-or-equal-to 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 wa s difficult and relapse or reinfection frequently occurred within a sh ort time after cessation of antibiotic, a second treatment course of g reater-than-or-equal-to 28 days (group 2) was given. By the end of the study, in which all patients were followed for a minimum of 36 days p ost 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 m edian number of days and standard error for group 1 to relapse or beco me reinfected was 16 +/- 2.5, and for group 2 it was 27 +/- 6. Develop ment of drug resistance was documented when bacteria isolated prior to any treatment were compared with strains isolated after greater-than- or-equal-to 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 questiona ble from both a medical-economic and microbiologic standpoint, particu larly in view of the likelihood of inducing multidrug resistance with prolonged antibiotic exposure.