Urinary Tract Infections in Patients with Spinal Cord Injury

Patients with spinal cord injury require either multiple repeated bladder catheterizations or long-term catheterization. The majority eventually develop asymptomatic bacteriuria, which may resolve spontaneously and recur and requires no diagnostics or treatment. Symptomatic urinary tract infection (UTI) is very frequent (~2.5 UTI episodes a year per patient). In these patients uropathogens typically form a biofilm on the bladder walls that prevents their eradication; thus, ≥90% of patients continue to have bacteriuria 30 days after discontinuation of treatment. The most frequently isolated pathogens are Proteus spp, Pseudomonas spp, Klebsiella spp, Serratia spp, and Providencia spp. In ~70% of patients >1 pathogen is identified.

Antibacterial treatment is started in patients with clinical signs and symptoms of UTI. Management is as in patients with complicated UTI and catheter-associated UTI.