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

Abstract

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. 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. 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. 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.