Ploypetch Teerada, Dajpratham Piyapat, Assanasen Susan, Thanakiatpinyo Thanitta, Tanvijit Phakamas, Karawek Jantra
Department of Rehabilitation Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Med Assoc Thai. 2013 Jan;96(1):99-106.
A prophylactic antibiotic in retrograde investigations (Ix) such as an urodynamic study was suggested by the European Association of Urology in order to prevent urinary tract infection (UTI) in the neurogenic bladder However finding an appropriate antibiotic is questionable since bacterial types and their sensitivities are variable in different settings. Therefore, the present study was aimed to find out the epidemiology of UTI in spinal cord injured (SCI) patients within the rehabilitation ward at Siriraj Hospital.
A retrospective chart review of 100 SCI patients admitted to the rehabilitation ward between 2006 and 2010 was done. Symptomatic UTI events, urine cultures, and sensitivities (C/S) were reviewed Demographic data and possible UTI-associated factors were collected and examined the association with the occurrence of UTI RESULTS: There were 64 males and 36 females with a mean age of 42.9 (SD 15.8) years. Most of them (77%) were injured at cervical and thoracic spinal cords. Forty-five patients had 57 UTI episodes. Escherichia coli was the most common isolated pathogen (50%), followed by Pseudomonas aeruginosa (17.3%), and Enterococcus faecalis (7.7%). The top three most sensitive antibiotics were imipenem, amikacin, and piperacillin/tazobactam. Unfortunately, gentamicin, ceftriaxone, and ciprofloxacin, which were frequently used as a prophylactic antibiotic, had the efficacy for only 51.9%, 38.5%, and 28.8% ofpathogens respectively. The mean length ofstay ofpatients with UTI was far greater than non-UTI patients, 45.5 (SD 24.4) versus 30.4 (SD 14.8) days (p = 0.001). Vesicoureteric reflux (VUR) (OR 21.2, 95% CI2.1 to 214.2) and increased intravesical pressure at storage phase (OR 1.1, 95% CI 1.004-1.113) were significant riSk factors for post investigation UTI.
UTI was commonly observed in SCI patients within the rehabilitation ward The most common uropathogen was Escherichia coli. Therefore, a prophylactic antibiotic such as amikacin should be prescribed in patients with VUR and increased intravesical pressure at storage phase.
欧洲泌尿外科学会建议在诸如尿动力学研究等逆行检查（Ix）中使用预防性抗生素，以预防神经源性膀胱患者发生尿路感染（UTI）。然而，由于不同情况下细菌类型及其敏感性各不相同，找到合适的抗生素存在疑问。因此，本研究旨在查明诗里拉吉医院康复病房内脊髓损伤（SCI）患者的尿路感染流行病学情况。
对2006年至2010年间入住康复病房的100例SCI患者进行回顾性病历审查。审查有症状的UTI事件、尿培养及药敏试验（C/S）。收集人口统计学数据和可能与UTI相关的因素，并检查其与UTI发生的关联。结果：有64例男性和36例女性，平均年龄42.9（标准差15.8）岁。其中大多数（77%）脊髓损伤发生在颈段和胸段。45例患者发生了57次UTI发作。大肠埃希菌是最常见的分离病原体（50%），其次是铜绿假单胞菌（17.3%）和粪肠球菌（7.7%）。最敏感的三种抗生素是亚胺培南、阿米卡星和哌拉西林/他唑巴坦。遗憾的是，经常用作预防性抗生素的庆大霉素、头孢曲松和环丙沙星，对病原体的有效率分别仅为51.9%、38.5%和28.8%。UTI患者的平均住院时间远长于非UTI患者，分别为45.5（标准差24.4）天和30.4（标准差14.8）天（p = 0.001）。膀胱输尿管反流（VUR）（比值比21.2，95%可信区间2.1至214.2）和储尿期膀胱内压升高（比值比1.1，95%可信区间1.004 - 1.113）是检查后UTI的显著危险因素。
在康复病房的SCI患者中普遍观察到UTI。最常见的尿路病原体是大肠埃希菌。因此，对于有VUR和储尿期膀胱内压升高的患者，应使用如阿米卡星这样的预防性抗生素。
