XML | Respond to this article | Alert & updates | Request permissions | Email to a friend |
Material and Method: A retrospective chart review of 100 SCI patients admitted to the rehabilitation ward between 2006 and 2010 was done. Symptomatic UTI events, urine cultures, and sensitivities (C/S) were reviewed. Demographic data and possible UTI-associated factors were collected and examined the association with the occurrence of UTI.
Results: There were 64 males and 36 females with a mean age of 42.9 (SD 15.8) years. Most of them (77%) were injured at cervical and thoracic spinal cords. Forty-five patients had 57 UTI episodes. Escherichia coli was the most common isolated pathogen (50%), followed by Pseudomonas aeruginosa (17.3%), and Enterococcus faecalis (7.7%). The top three most sensitive antibiotics were imipenem, amikacin, and piperacillin/tazobactam. Unfortunately, gentamicin, ceftriaxone, and ciprofloxacin, which were frequently used as a prophylactic antibiotic, had the efficacy for only 51.9%, 38.5%, and 28.8% of pathogens respectively. The mean length of stay of patients with UTI was far greater than non-UTI patients, 45.5 (SD 24.4) versus 30.4 (SD 14.8) days (p = 0.001). Vesicoureteric reflux (VUR) (OR 21.2, 95% CI 2.1 to 214.2) and increased intravesical pressure at storage phase (OR 1.1, 95% CI 1.004-1.113) were significant risk factors for post investigation UTI.
Conclusion: UTI was commonly observed in SCI patients within the rehabilitation ward. The most common uropathogen was Escherichia coli. Therefore, a prophylactic antibiotic such as amikacin should be prescribed in patients with VUR and increased intravesical pressure at storage phase.
Keywords: Urinary tract infection, Spinal cord injury, Epidemiology, Rehabilitation, Antibiotic, Vesicoureteric reflux