Actionable Nuggets for SCI (3rd ed., 2016)
Recurrent urinary tract infections (UTIs; more than 3 per year) in individuals with neurogenic bladder are a significant health concern. They are often polymicrobial, antibiotic-resistant, and caused by a much wider variety of pathogens than in the general population.
There is no superior agent or class of antibiotics for UTIs in spinal cord injury. Recurrent UTIs should be treated as complicated infections, and treatment must be customized to the patient and the infecting organism.
Evidence-based Best Practice:
Research shows the lack of an evidence-based standard of care for urinary tract infections in SCI. Guidelines for selecting antimicrobial agents in SCI patients include identification of the infecting organism and its antimicrobial susceptibility pattern, and assessment of host resistance and risk factors. Survey results show a tendency to over-treat UTIs in patients with SCI, resulting in antibiotic resistance. They also show poor compliance with matching culture sensitivity with antibiotic prescribed. The SCI population currently has higher resistance rates to a number of the usual treatments for bladder infection, such as ampicillin, sulphamethoxazole-trimethaprim and norfloxacin.
Once a symptomatic UTI is confirmed in an individual with SCI (see Nugget #13), treatment should be started without waiting for culture results. Short course (3-7 day) treatment may be used for simple infections (frequency of fewer than 3 per year), and long-course (7-14 days) should be prescribed for complex/recurrent UTI (> 3 infections per year). Routine prophylactic antibiotics should not be offered (for example, when changing indwelling catheters), and asymptomatic infections should not be treated with antibiotics, due to significant risk of antimicrobial resistance.
Hill, T. T. C., Baverstock, R., Carlson, K. V, Estey, E. P., Gray, G. J., Hill, D. C., … Parmar, R. (2013). Best practices for the treatment and prevention of urinary tract infection in the spinal cord injured population: The Alberta context. Canadian Urological Association Journal, 7(3-4), 122–30. http://doi.org/10.5489/cuaj.337
Additional references (chronological order):
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