Actionable Nuggets for SCI (2nd ed., 2013)
Individuals with spinal cord injury (SCI) have an increased risk of developing urinary tract infections (UTIs). Many individuals with SCI have asymptomatic bacteriuria or cells in their urine, but this does not constitute a UTI.
Diagnosis of UTI in SCI requires three criteria: (1) significant bacteriuria; (2) pyuria; AND (3) signs and symptoms.
Evidence-based Best Practice:
The diagnosis of UTI by irritative voiding symptoms (dysuria, urgency, polyuria) is made difficult by the presence of sensory impairment in SCI patients. Furthermore, asymptomatic pyuria and / or bacteruria is common in people with SCI. It is important to distinguish between asymptomatic bacterial colonization (which is virtually inevitable in SCI), and symptomatic infection.
Definitive diagnosis of UTI in SCI therefore requires all three criteria listed below:
- Significant bacteriuria
- ≥ 102 cfu/ml in those using intermittent catheterization
- ≥ 104 cfu/ml for clean-void specimens from catheter-free males with external condom collection
- ≥ 104 cfu/ml for spontaneous bladder management
- Any detectable concentration in those using indwelling catheters
- ≥ 50 WBC/hpf
- One or more of: (a) discomfort or pain over the kidney or bladder, or during urination; (b) onset of urinary incontinence; (c) increased spasticity; (d) autonomic dysreflexia; (e) cloudy urine with increased odour; (f) fever, malaise, lethargy, or sense of unease.
The quantitative criteria for significant bacteriuria in SCI have excellent sensitivity and specificity and underscore the need to consider type of bladder drainage when evaluating bacteriuri.
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