Defining Urinary Tract Infections
Urinary tract infections (UTIs) are a common secondary health condition following SCI and a major cause of morbidity (Charlifue et al. 1999; Vickrey et al. 1999). The most prevalent risk indicator of UTI in SCI patients is an indwelling catheter (Biering-Sorensen et al. 2002) or increased duration of catheterization (Foxman 2003). There are numerous ways that UTIs have been defined within individual studies with respect to either identifying the presence of UTIs and/or establishing treatment success. Although this diversity exists across studies, the criteria identified at the National Institute on Disability Rehabilitation Research (NIDRR) sponsored National Consensus Conference on UTI in 1992, and used in the 2006 Consortium for Spinal Cord Medicine Guidelines for Healthcare Providers, have become generally accepted standards for UTI definition. These stipulate that three criteria must be met before an individual with SCI is diagnosed with a UTI: 1) significant bacteriuria, 2) pyuria (urine containing increased white blood cells), and 3) signs and symptoms, as follows:
- Leukocytes in the urine generated by the mucosal lining
- Discomfort or pain over the kidneys or bladder, or during urination
- Onset of urinary incontinence or leakage around the catheter
- Fever or chills
- Anorexia
- Increased spasticity
- Autonomic hyperreflexia
- Cloudy, dark, and/or malodorous
- Malaise, lethargy, increased sweating, or sense of unease
Significant bacteriuria varies according to the method of urinary drainage and is defined by the following criteria: a) ≥102 colony-forming units of uropathogens per milliliter (cfu/mL) in catheter specimens from persons on intermittent catheterization, b) ≥104 cfu/mL in clean-voided specimens from catheter-free men using condom catheters, c) any detectable concentration of uropathogens in urine specimens from indwelling or SPC, and d) ≥105 cfu/mL for spontaneous management. Treatment of asymptomatic bacteriuria is not recommended, except in the cases of pregnancy and those undergoing urologic procedures (Nicolle et al. 2005) as it has been shown not to be effective and can actually create antimicrobial resistance. In addition, asymptomatic bacteriuria can be effectively treated with antiseptics and urinary alkalinizers or acidifiers (Salomon et al. 2006).
