Editing CUA: Neurogenic Lower Urinary Tract Dysfunction (2019) (section)

=== Infection ===

* '''Sepsis'''
* '''<span style="color:#ff0000">Urinary Tract Infections'''
** '''Pathogens'''
***'''The Enterobacteriaceae family represents the most commonly isolated organism in the NLUTD population, with E.coli comprising 50% of all strains.'''
**** '''This is a lower than non-neurogenic UTIs, partly explained by the increased incidence of Pseudomonas, Acinetobacter, Enterococcus, and fungi such as Candida'''
**'''<span style="color:#ff0000">Diagnosis and Evaluation'''
***'''The accepted definition of UTI in persons with NLUTD requires the presence of (3):'''
***#'''Leukocyturia'''
***#*Consensus cut-off for leukocyturia is 100 leukocytes/mL or any leukocyte esterase activity on dipstick
***#'''Bacteriuria'''
***#*No evidence-based cut-off values for bacteriuria; '''generally accepted guidelines:'''
***#**'''Any detectable concentration for suprapubic aspirate'''
***#**'''>102 cfu/ml (clean catheterized sample)'''
***#**'''>104 cfu/ml (clean voided)'''
***#'''Clinical symptoms'''
***#*'''<span style="color:#ff0000">Signs and symptoms of UTI in SCI''' 
***#*#'''<span style="color:#ff0000">Fever'''
***#*#'''<span style="color:#ff0000">Cloudy urine'''
***#*#'''<span style="color:#ff0000">Malodorous urine'''
***#*#'''<span style="color:#ff0000">Dysuria'''
***#*#'''<span style="color:#ff0000">Urinary incontinence/failure of control or leaking around catheter'''
***#*#'''<span style="color:#ff0000">Increased spasticity'''
***#*#'''<span style="color:#ff0000">Malaise'''
***#*#'''<span style="color:#ff0000">Lethargy or sense of unease'''
***#*#'''<span style="color:#ff0000">Back pain'''
***#*#'''<span style="color:#ff0000">Bladder pain'''
***#*#'''<span style="color:#ff0000">Autonomic dysreflexia'''
***'''Urine cultures should always be obtained prior to antimicrobial therapy due to the increased risk of nosocomial and multidrug-resistant microorganisms'''
**'''<span style="color:#ff0000">Management'''
***'''7-day course of antimicrobials is recommended for patients with prompt clinical response and 10–14 days for those with significant infection or a delayed response'''
***'''<span style="color:#ff0000">Prevention of UTI''' 
****'''<span style="color:#ff0000">Bladder management'''
***** '''<span style="color:#ff0000">When possible, CIC should be used over other methods'''
****** '''Risk of UTI: Transurethral indwelling catheterization carries >5x risk of recurrent UTIs when compared to suprapubic catheterization and CIC'''. '''Risk of UTI comparable between suprapubic, condom catheter, and CIC.'''
******* '''Condom catheters are effective and safe in select NLUTD patients''' (low PVRs and bladder storage pressures) '''but are significantly associated with Pseudomonas and Klebsiella bacteriuria and an incidence of UTI comparable to CIC'''.
****** Risk of stones: CIC and condom catheter lower risk than indwelling transurethral or suprapubic
***** <span style="color:#ff0000">'''Indwelling catheters should be changed every 2–4 weeks, with monthly being the most common interval'''
**** '''Antimicrobial prophylaxis'''
***** '''Routine antimicrobial prophylaxis for NLUTD UTI is not recommended for most patients'''
***'''<span style="color:#ff0000">Screening and treatment of asymptomatic bacteriuria in persons with NLUTD should be avoided''' as it promotes microbe resistance and can increase the likelihood of symptomatic UTI
****Exceptions to treat asymptomatic bacteriuria include pregnancy and prior to urological interventions where mucosal bleeding is expected