Uropathogens and Empiric Antibiotics for the Treatment of Urinary Tract Infections in Spinal Cord Injured Patients at Rehabilitation Center, Thai Red Cross Society during 2001 to 2005
Natthiya Tantisiriwat MD*, Wasuwat Kittisomprayoonkul MD**, Kwanyupa Sukonthamarn MD*, Chudaachhara Unhasuta ***, Chusana Suankratay MD, PhD****, Woraphot Tantisiriwat MD, MPH*****, Sek Aksaranugraha MD*
Affiliation : * Rehabilitation Center, Thai Red Cross Society, Bangkok ** Devision of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, Bangkok *** Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok **** Division of Infectious Disease, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok ***** Department of Preventive Medicine, Faculty of Medicine, Srinakharinwirot University, Bangkok
Background : Urinary tract infection (UTI) is common in spinal cord injured patients. The authors investi-
gated the epidemiology of bacteria associated with UTI to select an appropriate antibiotic for empirical
treatment of UTI before obtaining a bacterial culture.
Objective : To determine the prevalence, as well as the causative bacteria and their susceptibility pattern of
urinary tract infection in spinal cord injured patients hospitalized to the Rehabilitation Center, Thai Red
Cross Society, Samutprakarn, Thailand from January 2001 to December 2005.
Materials and Methods : A retrospective chart review of 76 spinal cord injured patients.
Results : Of all spinal cord injured patients, there were 50 males and 26 females, with the average age of 44.70
years. The average length of hospitalization was 104.5 days. 71.2% of the patients needed intermittent cath-
eterization for bladder drainage, and only 2.7% had suprapubic cystostomy. None of patient had indwelling
catheterization. Forty-six patients had 68 episodes of UTI (60.52%). Eighteen patients had recurrent UTI (14
patients had two episodes and four patients had three episodes). E. coli was the most common isolated
pathogen (74.36%) followed by K.pneumoniae (12.82%), E. faecalis (5%) and P. mirabilis (5%). Most gram-
negative pathogens were susceptible to amikacin and third generation cephalosporins. The susceptibility of
these organisms to cotrimoxazole, amoxicillin/clavulanate, and ciprofloxacin were in the range of 34.6-
60.0%, 44.0-50.0% and 25.9-50.0%, respectively.
Conclusion : Urinary tract infections were commonly observed among spinal cord injured patients in the
presented institution. E. coli was the most common isolated pathogen. Surprisingly, most gram-negative
pathogens were resistant to cotrimoxazole, amoxicillin/clavulanate, and ciprofloxacin. An antibiotic of choice
for UTI in our patients should be aminoglycoside or third generation cephalosporins.
Keywords : Spinal cord injury, Urinary tract infection, Intermittent catheterization
