PREVENTION OF URINARY-TRACT INFECTION IN PATIENTS WITH SPINAL-CORD INJURY - A MICROBIOLOGICAL REVIEW

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.