J Am Paraplegia Soc. 1992 Jul;15(3):194-204. doi: 10.1080/01952307.1992.11735873.
The Urinary Tract Infection Consensus Conference brought together researchers, clinicians, and consumers to arrive at consensus on the best practices for preventing and treating urinary tract infections in people with spinal cord injuries; the risk factors and diagnostic studies that should be done; indications for antibiotic use; appropriate follow-up management; and needed future research. Urinary tract infection (UTI) was defined as bacteriuria (102 bacteria/ml of urine) with tissue invasion and resultant tissue response with signs and/or symptoms. Asymptomatic bacteriuria represents colonization of the urinary tract without symptoms or signs. Risk factors include: over-distention of bladder, vesicoureteral reflux, high pressure voiding, large post-void residuals, presence of stones in urinary tract, and outlet obstruction. Possible physiologic/structural, behavioral, and demographic risk factors were identified also. Indwelling catheterization, including suprapubic, and urinary diversion are the drainage methods most likely to lead to persistent bacteriuria. Infection risk is reduced with intermittent catheterization, but more severely disabled people who require catheterization by others are at greater risk for UTIs. Clean self-intermittent catheterization does not pose a greater risk of infection than sterile self-intermittent catheterization and is much more economic. However, care must be given to proper cleansing of reusable catheters. Quantitative urine-culture criteria for the diagnosis of bacteriuria include: catheter specimens from individuals on intermittent catheterization greater than or equal to 10(2) cfu/ml; clean-void specimens from catheter-free males using condom collection devices greater than or equal to 10(4) cfu/ml; and specimens from indwelling catheters of any detectable concentration. Dip stick screening tests may offer promise as an early warning system of UTI since they can be self-administered. Symptomatic UTI should be treated with antibiotics for 7 to 14 days. Longer courses have not been beneficial. In patients with symptomatic UTIs, it is not necessary to wait for the results of cultures before starting treatment. Asymptomatic bacteriuria need not be treated with antibiotics. There is little evidence presently to support the use of antibiotics to prevent infections. Following a recent episode of febrile UTI, possible contributing prior events should be reviewed. The upper tracts should be evaluated (imaging studies) to identify possible abnormalities. A common concern among people with spinal cord injuries is that physicians will alter bladder management programs without regard to lifestyle needs. Social/vocational flexibility may be more important to them than a state-of-the-art bladder management program. Future research should focus on obtaining more representative samples and investigate psycho-social-vocational implications as well as additional clinical-medical factors.
尿路感染共识会议汇聚了研究人员、临床医生和患者，就脊髓损伤患者预防和治疗尿路感染的最佳实践、应进行的风险因素和诊断研究、抗生素使用指征、适当的后续管理以及未来所需研究达成共识。尿路感染（UTI）被定义为伴有组织侵袭以及由此产生的伴有体征和/或症状的组织反应的菌尿（每毫升尿液中细菌数≥10²）。无症状菌尿是指尿路定植但无任何症状或体征。风险因素包括：膀胱过度扩张、膀胱输尿管反流、高压排尿、排尿后大量残余尿、尿路结石以及出口梗阻。还确定了可能的生理/结构、行为和人口统计学风险因素。留置导尿（包括耻骨上导尿）和尿流改道是最有可能导致持续性菌尿的引流方法。间歇性导尿可降低感染风险，但需要他人协助导尿的重度残疾患者发生UTI的风险更高。清洁的自我间歇性导尿与无菌的自我间歇性导尿相比，感染风险并不更高，而且成本低得多。然而，必须注意对可重复使用导管进行适当清洁。诊断菌尿的定量尿培养标准包括：间歇性导尿患者的导管标本细菌数≥10² cfu/ml；使用避孕套收集装置的无导尿男性的清洁中段尿标本细菌数≥10⁴ cfu/ml；以及留置导尿标本中任何可检测到的浓度。试纸筛查试验有望作为UTI的早期预警系统，因为患者可自行操作。有症状的UTI应用抗生素治疗7至14天。疗程更长并无益处。对于有症状的UTI患者，开始治疗前不必等待培养结果。无症状菌尿无需用抗生素治疗。目前几乎没有证据支持使用抗生素预防感染。在近期发生发热性UTI后，应回顾可能的相关既往事件。应评估上尿路（影像学检查）以确定可能的异常情况。脊髓损伤患者普遍担心医生会在不考虑生活方式需求的情况下改变膀胱管理方案。对他们来说，社会/职业灵活性可能比最先进的膀胱管理方案更重要。未来的研究应侧重于获取更具代表性的样本，并调查心理-社会-职业影响以及其他临床-医学因素。
