Abstract
Objectives
To measure the prevalence of asymptomatic bacteriuria (ASB) in persons with spinal
cord injury (SCI) at the time of their annual examination and to examine the effect
on urine testing during the annual examination on subsequent antibiotic use.
Design
Retrospective cohort study.
Setting
A major SCI center.
Participants
Veterans (N=393) with SCI seen for an outpatient annual evaluation in 2012 or 2013.
Interventions
Not applicable.
Main Outcome Measures
Antibiotic use for bacteriuria within 7 days of the annual evaluation encounter.
Results
There were 327 clinic visits that met inclusion criteria; of these 327 veterans, 249
had a urine culture performed. A total of 171 urine cultures (69%) were positive for
bacteria, of which 22 (13%) represented urinary tract infection (UTI) cases and 149
(87%) were ASB cases. More than a third of the ASB cases (n=53 [36%]) were treated
with antibiotics. None of the 78 visits with negative urine cultures received antibiotics
to treat the UTI; thus, a positive urine culture alone was associated with antibiotic
use (P<.01). Factors predicting antibiotic use were higher age, nitrite presence on urinalysis,
and urease-producing organism on culture media. When comparing bladder management
strategies, indwelling catheterization was found to be associated with higher levels
of pyuria and hematuria than did spontaneous voiding or intermittent catheterization
(P<.01).
Conclusions
Two-thirds of the urine cultures of persons with SCI presenting for their annual examination
were positive. Most of the positive cultures represented ASB cases, and more than
a third of these were treated with antibiotics. A better understanding of the mandate
for urine testing at the annual examination and the outcomes of this practice is an
important first step in developing antibiotic stewardship for UTI in persons with
SCI.
Keywords
List of abbreviations:
AIS (American Spinal Injury Association Impairment Scale), ASB (asymptomatic bacteriuria), EMR (electronic medical record), IDSA (Infectious Diseases Society of America), SCI (spinal cord injury), UTI (urinary tract infection), VHA (Veterans Health Administration)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 26, 2017
Footnotes
Supported in part by the Department of Veterans Affairs, Veterans Health Administration Office of Research and Development, and the Center for Innovations in Quality, Effectiveness and Safety (grant no. CIN 13-413). Also supported in part by the National Institutes of Health (grant no. 5G12MD007605).
Disclosures: L. Grigoryan receives funding support from Zambon Pharmaceuticals. The other authors have nothing to disclose.
Identification
Copyright
Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
