Analysis of the factors influencing development of urinary tract infections in patients with spinal cord injuriеs

Aleksandra Sekulić; Aleksandra Karadzov Nikolic; Zoran Bukumiric; Goran Trajkovic; Aleksandar Corac; Slobodan Jankovic; Sasa Milicevic

doi:10.2298/6505

Aleksandra Sekulić Clinic for rehabilitation Dr M. Zotovic, Belgrade
Aleksandra Karadzov Nikolic Institute of Rheumatology, Belgrade
Zoran Bukumiric Institute of Statistics and Informatics, Faculty of Medicine, Belgrade
Goran Trajkovic Institute of Statistics and Informatics, Faculty of Medicine, Belgrade
Aleksandar Corac Medical Faculty Pristina, Department of preventive medicine, Kosovska Mitrovica
Slobodan Jankovic Institute of Pharmacology, Faculty of Medical Sciences, Kragujevac
Sasa Milicevic Clinic for rehabilitation Dr M. Zotovic, Belgrade

DOI: https://doi.org/10.2298/6505

Keywords: Urinary Tract, Prediction, Urinary Tract Infections, Spinal cord injury,

Abstract

Background/Aim. Urinary tract infections are still the most frequent complications in patients with spinal cord injury (SCI). The aim of this study was to analyze the factors influencing development of urinary tract infections during rehabilitation in patients with SCI. Methods. This retrospective case/control study including 540 patients with SCI which were rehabilitated in the Clinic for Rehabilitation “Dr Miroslav Zotović” between January 2000 and December 2009. We used patient files and other available medical documentation for obtaining information contained in this study, such as the manner of bladder emptying, the type of neurological disorder of the bladder, the neurological level and completeness of a lesion, the injury etiology, treatment method, secondary complications and associated injuries, kidney and bladder calculosis, age and sex. Results. Out of the total number of patients included in the study, 152 (28.1%) were without urinary tract infections, whereas 388 (71.9%) had urinary tract infections. There were 389 (72%) male and 151 (28%) female patients. The average age of patients without urinary tract infections was 51.0 ± 15.4 years, whereas the mean age of patients with urinary tract infections was 44.3 ± 16.9 years. The results of our study showed that the occurrence of urinary tract infections during rehabilitation in patients with SCIs was associated with the following factors: combined injuries (OR = 3.5), anemia (OR = 5.67), type of the bladder functional disorder (OR = 40–60) and crystals in urine (OR = 7.54). Conclusion. The physicians should take precautions and try to make the early diagnosis and rapid appropriate treatment of urinary tract infections in patients with SCI who also have functional bladder disorder, combined spinal injuries, anemia or urine crystals.

Key words:

spinal cord injuries; urinary tract infections; risk factors; urinary catheterization; multiple trauma; anemia; rehabilitation.

References

Wyndaele M, Wyndaele J. Incidence, prevalence and epidemiology of spinal cord injury: what learns a worldwide literature survey. Spinal Cord 2006; 44(9): 523−9.

Sekhon LH, Fehlings MG. Epidemiology, demographics, and pathophysiology of acute spinal cord injury. Spine 2001; 26(24 Suppl): S2−12.

Adriaansen JJ, van Asbeck FW, Lindeman E, van der Woude LH, de Groot S, Post MW. Secondary health conditions in persons with a spinal cord injury for at least 10 years: design of a comprehensive long-term cross-sectional study. Disabil Rehabil 2013; 35(13): 1104−10.

Ploypetch T, Dajpratham P, Assanasen S, Thanakiatpinyo T, Tanvijit P, Karawek J. Epidemiology of urinary tract infection among spinal cord injured patients in rehabilitation ward at Siriraj Hospital. J Med Assoc Thai 2013; 96(1): 99−106.

Togan T, Azap OK, Durukan E, Arslan H. The prevalence, etiologic agents and risk factors for urinary tract infection among spinal cord injury patients. Jundishapur J Microbiol 2014; 7(1): e8905.

Nicolle LE. Urinary tract infections in patients with spinal injuries. Curr Infect Dis Rep 2014; 16(1): 390.

Li L, Ye W, Ruan H, Yang B, Zhang S, Li L. Impact of hydrophilic catheters on urinary tract infections in people with spinal cord injury: systematic review and meta-analysis of randomized controlled trials. Arch Phys Med Rehabil 2013; 94(4): 782−7.

Afsar SI, Yemisci OU, Cosar SN, Cetin N. Compliance with clean intermittent catheterization in spinal cord injury patients: a long-term follow-up study. Spinal Cord 2013; 51(8): 645−9.

DeJong G, Tian W, Hsieh CH, Junn C, Karam C, Ballard PH, et al. Rehospitalization in the first year of traumatic spinal cord injury after discharge from medical rehabilitation. Arch Phys Med Rehabil 2013; 94(4 Suppl): S87−97.

Wu Q, Ning GZ, Li YL, Feng HY, Feng SQ. Factors affecting the length of stay of patients with traumatic spinal cord injury in Tianjin, China. J Spinal Cord Med 2013; 36(3): 237−42.

Abrams P. Urodynamics. 3rd ed. London: Springer-Verlag Limited; 2006.

American Spinal Injury Association/International Medical Society of Paraplegia (ASIA/IMSOP). International Standards for Neurological and Functional Classification of Spinal Cord Injury (Revised edition). Chicago: American Spinal Injury Association; 2000.

Kirshblum SC, Memmo P, Kim N, Campagnolo D, Millis S; American Spinal Injury Association. Comparison of the revised 2000 American Spinal Injury Association classification standards with the 1996 guidelines. Am J Phys Med Rehabil 2002;8 1(7): 502−5.

Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther 1987; 67(2): 206−7.

Aitkens S, Lord J, Bernauer E, Fowler WM, Lieberman JS, Berck P. Relationship of manual muscle testing to objective strength measurements. Muscle Nerve 1989; 12(3): 173−7.

Balsara ZR, Ross SS, Dolber PC, Wiener JS, Tang Y, Seed PC. Enhanced susceptibility to urinary tract infection in the spinal cord-injured host with neurogenic bladder. Infect Immun 2013; 81(8): 3018−26.

Jeong SJ, Cho SY, Oh SJ. Spinal cord/brain injury and the neurogenic bladder. Urol Clin North Am 2010; 37(4): 537−46.

Van Gool J, Tanagho EA. External sphincter activity and recurrent urinary tract infection in girls. Urology 1977; 10(4): 348−53.

Nazarko L. Management of a patient with diabetes and a hypotonic bladder. Nurs Times 2005; 101(47): 63−4.

Dunne JR, Malone D, Tracy JK, Gannon C, Napolitano LM. Perioperative anemia: an independent risk factor for infection, mortality, and resource utilization in surgery. J Surg Res 2002; 102(2): 237−44.

Grossman RG, Frankowski RF, Burau KD, Toups EG, Crommett JW, Johnson MM, at al. Incidence and severity of acute complications after spinal cord injury. J Neurosurg Spine 2012; 17(1 Suppl): 119−28.

Cuttitta F, Torres D, Vogiatzis D, Buttà C, Bellanca M, Gueli D, et al. Obesity and iron deficiency anemia as risk factors for asymptomatic bacteriuria. Eur J Intern Med 2014; 25(3): 292−5.

Rathor N, Khillan V, Sarin SK. Nosocomial candiduria in chronic liver disease patients at a hepatobilliary center. Indian J Crit Care Med 2014; 18(4): 234−7.

Dibua UM, Onyemerela IS, Nweze EI. Frequency, urinalysis and susceptibility profile of pathogens causing urinary tract infections in Enugu State, southeast Nigeria. Rev Inst Med Trop Sao Paulo 2014; 56(1): 55−9.

Torzewska A, Budzyńska A, Białczak-Kokot M, Różalski A. In vitro studies of epithelium-associated crystallization caused by uropathogens during urinary calculi development. Microb Pathog 2014; 71−72: 25−31.