Amaral Daniela M, Pereira Ana Margarida V C, Rodrigues Margarida R, Gandarez Maria de Fátima L, Cunha Maria R, Torres Marta S R
Department of Physical Medicine and Rehabilitation, Centro Hospitalar Universitário de São João, Porto.
Centro de Reabilitação do Norte, Valadares, Portugal.
Porto Biomed J. 2019 Nov 26;4(6):e56. doi: 10.1097/j.pbj.0000000000000056. eCollection 2019 Nov-Dec.
Urinary tract infection (UTI) is a common complication of spinal cord injury (SCI). Urodynamic testing is widely used for characterization of vesico-sphincteric dysfunction and for therapeutic orientation. As an invasive procedure, the risk of UTI is increased so, in some medical centers, antibiotic prophylaxis is instituted. Fosfomycin is one of the antibiotics used.
The aim of this study was to evaluate the incidence of UTI after urodynamics in patients with SCI, under fosfomycin prophylaxis.
Retrospective analysis was performed on patients with SCI, admitted to a rehabilitation center between January 2016 and June 2017, who underwent urodynamics studies under fosfomycin prophylaxis. Demographic data, risk factors for UTI-bacteriuria before urodynamics, high residual volume (>100 mL), bladder emptying method, vesico-sphincteric dyssynergia, and detrusor hyperactivity were analyzed. The incidence of UTI after urodynamics was evaluated.
The study included 84 patients, predominantly men 55 (65.5%). The mean age of the patients was 55.6 (18.9). Eleven (22.5%) had vesico-sphincteric dyssynergia, 32 (65.3%) detrusor hyperactivity and 22 (44.9%) had a high residual volume. Thirty-seven (44.1%) had asymptomatic bacteriuria before the urodynamics. Urinary complaints suggestive of UTI after urodynamics were observed in 2(2.4%) of patients, without significant bacteriuria and identification of bacterial agent.
The incidence of UTI after invasive procedures is reported between 3% and 20% in the literature, so antibiotic prophylaxis has been instituted, although controversial. In the study, in none of the patients the diagnosis of UTI was confirmed. Fosfomycin prophylaxis may have been important in reducing the incidence of UTI.
尿路感染（UTI）是脊髓损伤（SCI）的常见并发症。尿动力学检测广泛用于膀胱括约肌功能障碍的特征描述及治疗指导。作为一种侵入性操作，其会增加UTI的风险，因此在一些医疗中心会采取抗生素预防措施。磷霉素是所用的抗生素之一。
本研究旨在评估在磷霉素预防措施下，SCI患者尿动力学检查后UTI的发生率。
对2016年1月至2017年6月入住康复中心、在磷霉素预防措施下接受尿动力学检查的SCI患者进行回顾性分析。分析人口统计学数据、尿动力学检查前UTI-菌尿的危险因素、高残余尿量（>100 mL）、膀胱排空方法、膀胱括约肌协同失调及逼尿肌过度活动情况。评估尿动力学检查后UTI的发生率。
该研究纳入84例患者，以男性为主，共55例（65.5%）。患者的平均年龄为55.6岁（18.9岁）。11例（占22.5%）有膀胱括约肌协同失调，32例（占65.3%）有逼尿肌过度活动，22例（占44.9%）有高残余尿量。37例（占44.1%）在尿动力学检查前有无症状菌尿。2例（占2.4%）患者在尿动力学检查后出现提示UTI的尿路症状，但无明显菌尿且未鉴定出细菌病原体。
文献报道侵入性操作后UTI的发生率在3%至20%之间，因此尽管存在争议，但仍采取了抗生素预防措施。在本研究中，没有患者被确诊为UTI。磷霉素预防措施可能对降低UTI的发生率起到了重要作用。
