Title : Urinary bladder infection in spinal cord trauma
Abstract:
Introduction: One of the major complications of spinal cord injury is the neurologic bladder that no longer empties autonomously. Urinary tract infection (UTI) is a major cause of morbidity and mortality in these patients, and the objective of our study was to describe the clinical and microbiological aspects of UTI episodes in traumatized patients with neurological bladder.
Method: Descriptive retrospective study, conducted in the Infectious Diseases Department at the Kassab Institute of Orthopedics, including spinal cord trauma patients hospitalized for urinary bladder infection between June 2016 and December 2022.
Result: We collected 16 cases divided into 9 men and 7 women of average age equal to 50 years [20-74]. Fifteen patients had a spinal cord injury and only one had a cerebrospinal cord injury. Four patients had diabetes. Eleven patients were paraplegic, and five were quadriplegic. Urination was by intermittent self-catheterization in 13 cases and by indwelling bladder catheter in 3 cases. The main signs reported were fever (n=12), chills (n=10), flank pain (n=4), general health impairment (n=4), change in turbidity and odor of urine (n=3), overflow incontinence (3cases) and change in urination rhythm (2cases). Two patients had concurrent nephrolithiasis. Thirteen patients had biological inflammatory syndrome. Only 5 patients had positive blood cultures. Leukocyturia was pathological in all patients. Organisms isolated from urine culture were mainly Escheria .Coli (8 cases), Klebsiella pneumoniae (5 cases), Proteus Mirabilis (2 cases), Acinetobacter baumanii (1 case). Renal ultrasonography performed in all patients did not show renal puration foci. Antibiotic therapy was 3rd (n=11) cephalosporin, imipenem (n=5). Four patients had received an aminoglycoside in combination.
The mean duration of antibiotic therapy was 16 days with a favorable initial course in all patients.
The subsequent course was marked by recurrences in 8 patients (on average 2 to 3 recurrences per year). Escheria Coli and klebsiella pneumoniae were the most isolated organisms in these recurrences.
Conclusion: Clinical presentation of UTIs on a neurologic bladder is often atypical. Complicated sepsis can be life threatening, and recurrences are common. Proper antibiotic treatment is the only guarantee of a better functional and vital prognosis.
