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The effect of appropriate bladder management on urinary tract infection rate in patients with a new spinal cord injury: a prospective observational study

  • Derek B. HennesseyEmail author
  • N. Kinnear
  • L. MacLellan
  • C. E. Byrne
  • J. Gani
  • A. K. Nunn
Original Article
  • 74 Downloads

Abstract

Purpose

This study aimed to determine the rate of urinary tract infection (UTI) in patients with a new spinal cord injury (SCI) and identify which bladder management technique is associated with the lowest rate of UTI.

Methods

Adults admitted to the Victorian Spinal Cord Service with a new SCI from 2012 to 2014 were enrolled. Data collected included patient characteristics, SCI level, bladder management and diagnosis of UTI. Bacteriuria (≥ 102 colony-forming organisms/mL) with clinical signs of infection was used to define a UTI.

Results

143 patients were enrolled. 36 (25%) were female; the median age was 42 years. An indwelling urethral catheter (IUC) was placed in all the patients initially. 55 (38%) patients developed a UTI with an IUC, representing a UTI rate of 8.7/1000 inpatient days. Long-term bladder management strategies were initiated after a median of 58 days. IUC removal and initiation of any other alternative bladder management halved the UTI rate to 4.4/1000 inpatient days, p < 0.001. Intermittent self-catheterisation (ISC) and suprapubic catheter placement had lower UTI rates compared to IUC, 6.84 and 3.81 UTI/1000 inpatient days, p = 0.36 and p = 0.007, respectively. An IUC was re-inserted in 29 patients and resulted in a higher UTI rate of 8.33/1000 inpatient days.

Conclusion

This study has identified a high UTI rate in new SCI patients with an IUC and reinforces the importance of early IUC removal and initiation of non-IUC bladder management in this cohort of patients.

Keywords

Spinal cord injury Urinary tract infection Bladder management 

Notes

Author contributions

DH wrote the paper and did the statistical analysis. NK helped to write the paper and did the statistical analysis. LM did data collection and statistical analysis and helped to refine the final manuscript. CB did data collection and helped to refine the final manuscript. JG assisted in analysis and helped to refine the final manuscript. AN created the report concept and helped to refine the final manuscript.

Funding

This study was funded by a Grant from the Institute for Safety, Compensation and Recovery Research (ISCRR).

Compliance with ethical standards

Conflict of interest

No potential conflict of interest relevant to this article was reported.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Victorian Spinal Cord ServiceAustin HealthHeidelbergAustralia
  2. 2.Department of UrologyAustin Health, University of MelbourneMelbourneAustralia
  3. 3.Department of Urology, Western HealthUniversity of MelbourneMelbourneAustralia

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