Localization of urinary tract infection in patients with spinal cord injury

The site of urinary tract infection (UTI) was localized in asymptomatic bacteriuric patients with spinal cord injury who underwent intermittent bladder catheterization by the bladder washout (BWO) test, antibody-coated bacteria (ACB) test, quantitative urinary leukocyte count, ultrasonography, and excretory urography. Thirty-two (43%) of 74 UTIs were localized by BWO to the upper tract and 42 (57%) to the lower tract. Sensitivity of the ACB test in detecting upper UTI as defined by BWO was 0.28, and specificity was 0.86. The median urinary leukocyte count in 22 BWO-positive infections tested was 420 vs. 94 in 24 BWO-negative infections (P = .01). Patients with polymicrobic infections or with upper tract abnormalities, as detected by ultrasound or excretory urography, were more likely to have BWO-positive infections. We conclude that negative BWOs are usually associated with negative ACB tests in this population, but further comparisons of both tests with ureteral catheterization are needed to clarify the meaning of results in either assay.