A. Galloway, PREVENTION OF URINARY-TRACT INFECTION IN PATIENTS WITH SPINAL-CORD INJURY - A MICROBIOLOGICAL REVIEW, Spinal cord, 35(4), 1997, pp. 198-204
The importance of urinary tract infection (UTI) in patients with spina
l cord injury cannot be understated. Many patients with significant ba
cteriuria are considered to be colonised rather than infected. and tre
atment should be reserved for those with clinical symptoms or other si
gns of infection.(1) Published research on the prevention and manageme
nt of UTI in patients with spinal cord injury often has limitations du
e to differences in definitions of UTI, studies on groups using differ
ent urinary drainage appliances, the mixture of newly injured and. lon
gstanding injured patients and studies being carried out predominantly
on male patients.(2) The complications due to UTI and the difficultie
s in treating established infection mean that prevention is essential.
Close urological follow-up is crucial in ensuring that adequate bladd
er drainage is achieved avoiding the use of long term indwelling urina
ry catheters if at all possible.(3) For those patients who require lon
g term urinary appliances patient education and strict attention to hy
giene and catheter care policies is important. The role of antiseptic/
antibiotics is strictly limited in preventing UTI in patients with spi
nal cord injury and may even be harmful. Further study into which grou
ps of patients may benefit from the use of antiseptics or antibiotics
is urgently required. Continued research into different methods of pre
vention eg by vaccination, immunotherapy, the use of receptor analogue
s and bladder interference should also be encouraged.