Editing Urinary Tract Infections (section)

== UTIs in patients with spinal-cord injury (SCI) ==

=== Pathogenesis ===
* Risk factors include impaired voiding, overdistention of the bladder, elevated intravesical pressure, increased risk of urinary obstruction, vesicoureteral reflux, instrumentation, increased incidence of stones, decreased fluid intake, poor hygiene, perineal colonization, decubiti, and other evidence of local tissue trauma, and reduced host defense associated with chronic illness

=== Pathogens ===
* Most bacteriuria in short-term catheterization is of a single organism, whereas patients catheterized for longer than a month will usually demonstrate a polymicrobial flora caused by a wide range of gram-negative and gram-positive bacterial species

=== Diagnosis and Evaluation ===
* The majority of patients with SCI with bacteriuria are asymptomatic. Because of a loss of sensation, patients usually do not experience frequency, urgency, or dysuria. More often, they complain of flank, back, or abdominal discomfort, leakage between catheterizations, increased spasticity, malaise, lethargy, and/or cloudy, malodorous urine.
* '''UTI is the most common cause of fever in the SCI patient'''

=== Management ===
* '''CIC has been shown to decrease lower urinarcy tract complications by maintaining low intravesical pressure and reducing the incidence of stones. CIC also appears to reduce complications associated with an indwelling catheter, such as UTI, fever, bacteremia, and local infections such as epididymitis and prostatitis.'''
** Suprapubic catheters and indwelling urethral catheters eventually have an equivalent infection rate. However, the onset of bacteriuria may be delayed using a suprapubic catheter compared with a urethral catheter (different than NLUTD guidelines which suggest decreased infection rate with suprapubic compared to indwelling)
** '''In the absence of vesicoureteral reflux, asymptomatic bacteruria in patients managed with clean intermittent catheterization is not a significant risk factor for renal damage and does not require antibiotic therapy.'''
* '''Only symptomatic patients require therapy'''.
** Because of the diverse flora and high probability of bacterial resistance, a urine culture must be obtained before initiating empirical therapy.
** '''For afebrile patients, an oral fluoroquinolone is the agent of choice.'''
* '''An indwelling catheter should be changed to ensure maximal drainage and eliminate bacterial foci in catheter encrustations'''.
* '''Antimicrobial prophylaxis is not supported for most patients who have neurogenic bladder caused by spinal cord injury'''