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Urinary tract infections occurring in recent spinal cord injury patients on intermittent catheterization
Abstract:
During a 28-month interval 70 spinal cord injury patients in the initial rehabilitation hospitalization underwent 5,052 days of intermittent catheterization. Intermittent catheterization was done with a sterile technique and a neomycin-polymyxin irrigant. At the time of transfer to our facility 39 patients were using Foley catheter drainage but no difficulty was encountered when these patients were changed to intermittent cateterization. While on intermittent catheterization 52 urinary tract infections occurred, half caused by gram-positive cocci, 24 by gram-negative bacilli and 2 by Candida albicans. These infections occurred in 38 patients (54 per cent) at an over-all rate of 10.3 infections per 1,000 patient-days of intermittent catheterization. Only 2 infections were symptomatic and these occurred in patients on pass who unilaterally discontinued intermittent catheterization. Only 6 infections were not cured by antimicrobial therapy. Urinary tract infection was less common in patients who had incomplete spinal cord injuries. Infections caused by organisms susceptible to the irrigant containing neomycin-polymyxin occurred almost exclusively in patients catheterized 3 or fewer times daily. Infection was rare after 3 months on intermittent catheterization. Intermittent catheterization with our technique poses little infection hazard and can be introduced readily in acute spinal cord injury patients before transfer to specialized facilities.
Insights
Intermittent catheterization for spinal cord injury patients is safe and effective, with a low risk of urinary tract infections when using sterile techniques and a neomycin-polymyxin irrigant.
Area of Science:
- Urology
- Nephrology
- Rehabilitation Medicine
Background:
- Spinal cord injury (SCI) frequently necessitates urinary bladder management.
- Indwelling urinary catheters pose a significant risk of infection.
- Intermittent catheterization (IC) is an alternative management strategy.
Purpose of the Study:
- To evaluate the safety and efficacy of intermittent catheterization in SCI patients.
- To assess the incidence and characteristics of urinary tract infections (UTIs) during IC.
- To determine the infection risk associated with a specific IC technique and irrigant.
Main Methods:
- Prospective study of 70 SCI patients over 28 months.
- Utilized sterile technique and a neomycin-polymyxin irrigant for IC.
- Monitored patients for UTIs and analyzed causative organisms and risk factors.
Main Results:
- 52 UTIs occurred in 38 patients (54%) over 5,052 days of IC (10.3 infections/1000 patient-days).
- Most infections were asymptomatic and successfully treated; only 2 were symptomatic.
- Lower UTI rates were observed in incomplete SCI, with prolonged use (>3 months), and with susceptible organisms.
Conclusions:
- Intermittent catheterization with sterile technique and neomycin-polymyxin irrigant poses minimal infection risk in acute SCI patients.
- This method is readily implementable before transfer to specialized facilities.
- IC is a safe and effective bladder management option for SCI rehabilitation.