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Urinary Tract Infections in Spinal Cord Injury

Epidemiology and Pathophysiology

There is a heightened risk of urinary tract infection (UTI) in patients with a spinal cord injury (SCI). Lower rates occur in those with incomplete injuries. The overall incidence of urinary tract infection in SCI is 2.5 cases per year.
In patients practicing clean intermittent catheterization, the mean incidence of UTIs is 10.3 cases per 1000 catheter days; after 3 months, the rate is fewer than 2 cases per 1000 catheter days. Once a urethral catheter is in place, the daily incidence of bacteriuria is 3-10%. Because most patients become bacteriuric by 30 days, that is a convenient dividing line between short- and long-term Pathogenetic factors include bladder overdistention, vesicoureteral reflux, high-pressure voiding, large postvoiding residual volume, stones in the urinary tract, and outlet obstruction.

Patients with SCI develop UTIs with microorganisms that form dense biofilms on the bladder wall; thus, these infections are difficult to eradicate. Organisms that commonly cause infections include Proteus, Pseudomonas, Klebsiella, Serratia, and Providencia species, along with enterococci and staphylococci. Approximately 70% of infections are polymicrobial.

There is a significant correlation between UTI in patients undergoing rehabilitation for traumatic SCI and decreased gains in functional independence measures.

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