Definition of UTI 

Definition of UTI in SCI patients

  • Bacteriuria: isolation of bacteria in the urine [Selzman 1993]
    • Quantitative urine-culture criteria for the diagnosis of bacteriuria:
      • ≥100 cfu/ml: catheter specimens from individuals on intermittent catheterization
      • ≥10000 cfu/ml: clean-void specimens from catheter-free males using condom collection devices
      • any detectable concentration: specimens from indwelling catheters
  • Asymptomatic bacteriuria: colonization of the urinary tract without symptoms or signs [NIDDK 1992]
  • UTI: microbial invasion of any of the tissue of the urinary tract and resultant tissue response with signs and/or symptoms [Selzman 1993]
  • Simple UTI:
    • Simple infection of the urinary tract associated with no structural abnormalities
  • Complicated UTI:
    • Associated with functionally, metabolically, or anatomically abnormal urinary tract [Carson 1993]:
      • lower urinary tract abnormalities (such as neurogenic bladder, obstruction, postvoid residual urine, retention, etc) and
      • upper urinary tract abnormalities (such as obstruction, chronic pyelonephritis, urinary stone, etc)
    • or that are caused by pathogens that are resistant to antibiotics [Stamm 1993]

Clinical significance

  • Simple UTI:
    • Majority of UTI encountered in office practice
  • Complicated UTI:
    • Most difficult to treat and eradicate
    • Are potentially the most serious as a cause of life-threatening illness
    • UTIs in SCI population are considered complicated.

Detection of UTI

  • Dip stick screening tests may offer promise as an early warning system of UTI since they can be self-administered [NIDDK 1992]. However when compared to microscopic analysis and culture they are inaccurate
  • The classic symptoms of UTI are unreliable indicators in SCI patients with neurogenic bladder. [Garcia Leoni 2003]. For more information, please refer to this
  • Individuals with SCI were frequently not accurate at predicting whether they had a UTI based on their symptoms [Linsenmeyer 2003]
  • Lack of pyuria reasonably predicts the absence of UTI in SCI patients. [Garcia Leoni 2003]
  • Asymptomatic bacteriuria need not be treated with antibiotics [Garcia Leoni 2003]. For more information, please refer to this
Key Points of This Section
  • Distinguishing an infection from colonization is not easy.
  • Fever, pyuria, tissue inflammation on endoscopy, help to detect a true infection.
  • Other symptoms: incontinence, cloudy urine, headache, fatigue, anorexia for example are not signs of a UTI.
  • Symptomatic infections mandate evaluation of urinary tract function.

References

  • Carson CC 3rd. Antimicrobial agents in urinary tract infections in patients with spinal cord injury. Urol Clin North Am. 1993 Aug;20(3):443-52.
  • Garcia Leoni ME, Esclarin De Ruz A. Management of urinary tract infection in patients with spinal cord injuries. Clin Microbiol Infect. 2003 Aug;9(8):780-5.
  • Garcia Leoni ME, Esclarin De Ruz A. Management of urinary tract infection in patients with spinal cord injuries. Clin Microbiol Infect. 2003 Aug;9(8):780-5.
  • Linsenmeyer TA, Oakley A. Accuracy of individuals with spinal cord injury at predicting urinary tract infections based on their symptoms. J Spinal Cord Med. 2003 Winter;26(4):352-7.
  • Selzman AA, Hampel N. Urologic complications of spinal cord injury. Urol Clin North Am. 1993 Aug;20(3):453-64.
  • Stamm WE, Hooton TM. Management of urinary tract infections in adults. N Engl J Med. 1993 Oct 28;329(18):1328-34.
  • The prevention and management of UTIs among people with spinal cord injuries. National Institute on Disability and Rehabilitation Research Consensus Statement. January 27-29, 1992, J Am Paraplegia Soc. 1992 Jul;15(3):194-204.

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