Assessment of Urinary Tract Infections and Antimicrobial Resistance in a Spinal Cord Injury Rehabilitation Unit

Abstract

Introduction: Our objective was the identification and characterization of the bacterial spectrum and of its susceptibility to antibiotics in patients treated in a Spinal Cord Injury Unit. The determination of the role played in the infections by the vesical emptying method and the medullar injury, as classified by the International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI).

Material and Methods: We retrospectively analyzed 79 patients who had been hospitalized in a Spinal Cord Injury Unit between 1/09/2014 and 1/09/2015. One hundred and fifty-eight urine samples were collected and sent for bacteriological examination. The urine samples were collected only in cases where there was clinical suspicion of a UTI. The variables taken into account were: gender, age, ISCNCSCI classification, antibiotic therapy applied, microorganisms isolated in the urine cultures, the method employed to bladder emptying at the time of the infection, and the profile of resistance to antibiotics.

Results: We found that 75.9% of patients contracted at least one UTI in our Spinal Cord Injury Unit, with a higher frequency detected among those subjected to a urinary catheterization technique. Patients undergoing continuous catheterization presented a higher number of UTIs than those on intermittent catheterization. The most common bacteria isolated were Klebsiella pneumoniae (43%) and Escherichia coli (22.8%). We determined that 71.5% of the isolated bacteria were multidrug-resistant. The highest rates of resistance (82%) were found among patients undergoing continuous catheterization (p < 0.05).

Conclusion: Klebsiella pneumoniae was the most frequent bacterial cause of UTIs in our unit. Our results are consistent with scientific reports describing increasingly higher levels of bacterial resistance to drugs, as well as a higher rate of multi-resistant infections within the population with SCI. Intermittent catheterization is preferable, since most UTIs were reported among patients undergoing continuous catheterization. AIS D patients, and those with spontaneous urination, exhibited a lower rate of infection. These results are food for thought on the antimicrobial resistance of bacteria and on the need for the development of alternative strategies to prevent UTIs.