The Stockholm Spinal Cord Uro Study: 2. Urinary tract infections in a regional prevalence group: frequency, symptoms and treatment strategies. (3rd March 2020)

• Record Type: Journal Article
• Authors: Farrelly, Elisabeth; Lindbo, Lena; Wijkström, Hans; Seiger, Åke
• Is Part Of: Scandinavian journal of urology. Volume 54:Number 2(2020)
• Page Start: 155
• Page End: 161
• Publication Date: 2020-03-03
• Subjects: Spinal cord injury -- urinary tract infection -- Asymptomatic bacteriuria -- epidemiology -- prevalence group -- risk factors for urinary tract infection; Urology -- Periodicals; 616.6
• DOI: 10.1080/21681805.2020.1734078
• Languages: English
• ISSNs: 2168-1805

Abstract

Abstract: Objective: To examine symptomatic urinary tract infections (UTI) in a regional prevalence group of patients with traumatic spinal cord injury (SCI), to assess risk factors for recurring infections and to identify a high-risk sub-population for frequently recurring and severe febrile UTIs. Materials and Methods: Four hundred and twelve patients who attended a yearly check-up at the Spinalis SCI clinic were included. A regional programme for neurogenic bladder dysfunction was applied, including S-creatinine and S-cystatin-C, urine culture, residual urine, ultrasound of kidneys, urodynamic studies and a questionnaire regarding complications during the preceding year. Descriptive statistics and regression analysis were used to estimate risk factors. Results: Nearly half of all patients reported ≥1 UTI during the preceding year with a mean number of 3.6. Persons who use normal voiding had the lowest frequency, while those with catheter-assisted voiding reported the highest numbers. A sub-group of patients had more frequent and severe UTIs. They were characterized by a cervical or thoracic neurological level lesion and a more severe injury and the presence of SCI-related complications such as spasticity, neuropathic pain and autonomic dysreflexia. The most common signs and symptoms of UTI were smelly and cloudy urine, feelings of malaise and increased spasticity. Conclusions: Risk profiles for recurring and severe UTIs were catheter-assisted voiding, cervical or thoracic levels and more complete neurological lesions and the co-existence of other SCI-related complications. There is a need for an increased understanding of the special symptoms of UTI in this patient group and a strategy to avoid unspecific antibiotic treatment.