Treatment of urinary tract infection in persons with spinal cord injury: guidelines, evidence, and clinical practice

Abstract

Objectives: To investigate current clinical practice in the treatment of urinary tract infections (UTIs) in persons with spinal cord injury (SCI) in SCI centers where German is spoken and to compare it with current guidelines and evidence-based standards evaluated by a literature review.

Methods: A standardized questionnaire was mailed to 16 SCI rehabilitation centers. The results were compared with a literature review

Results: Of the 16 centers, 13 responded. Indications for UTI treatment, medications, and treatment duration differed substantially among the individual centers and from the existing guidelines. Antibiotic treatment is regarded as the method of choice. Compared with the existing literature, patients in two center were undertreated, whereas they were overtreated in seven centers.

Conclusion: Even in specialized centers, treatment of UTI in patients with SCI is based more on personal experience of the treating physicians than on published evidence. This may at least partly be due to the paucity of evidence-based data. The observed tendency toward overtreatment with antibiotics carries substantial future risks, as this strategy may well lead to the induction of multiresistant bacterial strains. Therefore, developing guidelines would be an important step toward a unification of the different treatment strategies, thus reducing unnecessary antibiotic treatment. Furthermore, evidence-based studies evaluating the success of antibiotic treatment as well as the usefulness of alternative strategies are urgently needed.

Keywords:

• Urinary tract infection
• Spinal cord injuries
• Evidence-based medicine
• Clinical guidelines
• Antibiotic therapy
• Neurogenic bladder
• Cephalosporins
• Fluoroquinolones
• Cotrimoxazole
• Homeopathy

Acknowledgements

I thank the colleagues below for contributing questionnaires: Jörn Bremer (Greifswald, Germany), Harald Burgdörfer (Hamburg, Germany), Wolfgang Diederichs (Berlin, Germany), Konrad Göcking (Nottwil, Switzerland), Ulrike Hohenfellner (Heidelberg, Germany), Albert Kaufmann (Mönchengladbach, Germany), Gustav Kiss (Innsbruck, Austria), Ines Kurze (Bad Berka, Germany), Johannes Kutzenberger (Bad Wildungen, Germany), Ulrich Mehnert (Balgrist, Switzerland), Sandra Möhr (Basel, Switzerland), Andreas Redecker (Halle, Germany), Arndt van Ophoven (Bochum, Germany).