Treatment of urinary tract infections in persons with spinal cord injury: a review

Despite improvements in the techniques to drain the urinary bladder in patients with spinal cord injury (SCI), urinary tract infection (UTI) remains one of the most common complications of SCI. Despite many studies of the management of UTIs, differences of opinion remain. This has resulted from the use of different definitions of UTI, including the definitions of "significant" bacteriuria, "asymptomatic" bacteriuria, the inclusion (or exclusion) of "soft" symptoms, evidence of few complications from the infection and other risks of infection. The need to treat patients with high fever who may have bacteremia and patients with symptoms is clear. Broad coverage may be necessary until the results of culture are available because of the frequent presence of resistant bacteria colonizing the perineum or bowel. Eradication of bacteriuria is not a reasonable goal in many patients with indwelling catheters. The treatment of patients with asymptomatic bacteriuria (those patients without symptoms or pyuria) remains controversial. Asymptomatic bacteriuria is often treated in recently injured inpatients and those that have their first infection and is not treated in persons in whom asymptomatic bacteriuria is detected more than one year following the injury. Selection of the antibiotics depends on the symptoms of UTI, but at the risk of developing colonization of the urinary tract, perineum, or bowel with resistant gram-negative bacilli.