Department Neuro-Urology, BG Trauma Hospital Hamburg, Hamburg, Germany.
Spinal Cord. 2013 Jan;51(1):70-3. doi: 10.1038/sc.2012.107. Epub 2012 Sep 11.
Non-interventional, descriptive-observational cohorts study.
To assess the incidence of urinary tract infection (UTI) after urodynamic examination in patients with spinal cord injury (SCI) according to bladder management.
Level 1 trauma center.
Between January and December 2010 a total of 133 consecutive, hospitalized SCI patients were included and classified according to their bladder management. Urine specimen was obtained at the beginning of the urodynamic studies (UDS) and 3-5 days thereafter. 'Significant bacteriuria' (SBU) is defined by a CBU per ml level ≥10(5) in a urine culture. UTI thus is defined as a combination of a SBU and ≥100 leukocytes per μl in urine analysis.
The overall incidence of UTI post UDS was 15.79%. In patients with sterile urine prior to urodynamics UTI was ascertained in 8.6% (de-novo-UTI). In contrast, 32.5% of the patients with SBU prior to UDS showed UTI 3 days later. There were only minor differences in the incidence of de-novo-UTIs in SCI patients who emptied their bladder by intermittent self catheterization or intermittent catheterization by attendant (8.82% and 6.67%, respectively). In SCI patients with reflex voiding however, the frequency of de-novo-UTIs was twice as high (14.28%).
The recommendation of antibiotic prophylaxis for all SCI patients undergoing urodynamic examination is not commonly accepted and according to our data not justified. However, the analysis of subgroups revealed that SCI patients with unsuspected SBU prior to UDS and patients with reflex voiding are possibly at higher risk to acquire post-UDS infection.
非介入性、描述性观察队列研究。
根据膀胱管理情况，评估脊髓损伤（SCI）患者在尿动力学检查后发生尿路感染（UTI）的发生率。
1 级创伤中心。
2010 年 1 月至 12 月期间，共纳入 133 例连续住院的 SCI 患者，并根据其膀胱管理情况进行分类。在尿动力学研究（UDS）开始时和之后 3-5 天获取尿液标本。“显著菌尿”（SBU）定义为尿液培养中每毫升水平≥10（5）的 CBU。因此，UTI 定义为 SBU 与尿液分析中≥100 个白细胞/μl 的组合。
UDS 后 UTI 的总体发生率为 15.79%。在 UDS 前尿液无菌的患者中，UTI 的发生率为 8.6%（新发 UTI）。相比之下，32.5%的 UDS 前存在 SBU 的患者在 3 天后出现 UTI。间歇性自我导尿或由护理人员间歇性导尿排空膀胱的 SCI 患者新发 UTI 的发生率差异较小（分别为 8.82%和 6.67%）。然而，对于反射性排尿的 SCI 患者，新发 UTI 的频率则高出两倍（14.28%）。
不推荐所有接受尿动力学检查的 SCI 患者预防性使用抗生素，这一建议在我们的数据中并未得到支持。然而，对亚组的分析表明，UDS 前存在未被怀疑的 SBU 的 SCI 患者和具有反射性排尿的患者可能更易在 UDS 后发生感染。
