Bacteriuria in patients with spinal cord lesions: its relationship to urinary drainage appliances

Urine cultures from spinal cord injuried patients demonstrate a high incidence of bacteriuria, with patterns of bacteriuria varying with the mode of drainage. The highest incidence of positive cultures occurs in patients with indwelling or suprapubic catheters, and the lowest in patients who are appliance-free. The organisms occurring most frequently differ from those of the general hospital population as reported by Needham, Smith and Matsen. There is an increase in the incidence of Pseudomonas, Proteus and Serratia and a decrease in the occurrence of E coli and Klebsiella. Sixty-four percent of the organisms occurred in concentrations of 100,000 col/ml or greater, and 65% of all positive cultures contained multiple species of organisms. Cultures taken from urinary collecting appliances and hands demonstrate possible sources of bacteriuria and the need for careful training and education of patients and their attendants and constant monitoring of urinary tract appliance care.