Urinary tract infections
Why are people with spinal cord injury at higher risk of developing urinary tract infections?
Urinary tract infections (UTIs) are a common secondary health condition following spinal cord injury (SCI) and are a major cause of morbidity. People with SCI are at increased risk of UTIs due to altered bladder function and the use of catheters. Complicated UTIs occur in people with anatomical or functional abnormalities such as neurogenic bladder, calculi or diabetes.
Recommendations for preventing infections
- Make sure hands are washed prior to and after handling catheters, drainage bags or bottles.
- Maintain a closed drainage system. A closed catheter system postpones bacteriuria or bacterial growth in the urine. A closed system is a one-way flow of urine from the bladder with no breaks in the system.
- Use soap and water or wet wipes on the skin prior to inserting a catheter. Other solutions can dry and damage the sensitive skin around the genital area (alcohol rubs are only suitable for the hands).
- Clip the hair around the suprapubic catheter site to avoid introducing a hair (foreign body) into the bladder.
- Change and wash clothes every day.
- Insert the catheter using an aseptic technique.
- Ensure that the flow of urine is unobstructed.
- Suprapubic catheters are preferred for long-term use instead of urethral indwelling catheters.
What are the common signs and symptoms?
The common signs and symptoms of a UTI for people with SCI are:
- Cloudy urine with increased odour, mucous or sediment
- Urinary incontinence
- Fever
- Chills and rigors
- Urgency
- Increased sediment or blocking catheters
- Increased spasticity
- Lethargy
- Poor appetite
- Pain or discomfort over the kidneys/bladder
- Painful urination
- Haematuria
- Excessive sweating
- Nausea and vomiting
- Confusion especially in the elderly
- Autonomic dysreflexia
Testing for an infection
Urine dipsticks
Urine dipsticks can be effective for use in the healthcare and/or home environments. If both nitrates and leucocytes are present, this indicates a positive UTI result.
Culture / mid-stream urine
One-third of UTIs in people with SCI are polymicrobial. A urine culture or mid-stream urine (MSU) test can identify specific micro-organisms, to ensure the most appropriate antibiotic is prescribed.
Culture results should be taken with a newly inserted (sterile) catheter (either indwelling or intermittent).
What to do if a urinary tract infection is suspected?
- Increase fluids (water) to 2-3 litres daily, unless otherwise advised by the doctor.
- Review hygiene, in relation to:
- Insertion of catheters
- Emptying the urine bag
- Urethra, meatal or stomal area, at site of catheter insertion
- Review the bowel routine as this may impact the risk of developing a UTI.
- Support the immune system through a healthy diet, managing stress and a good sleeping pattern.
- Use antibiotics as prescribed for symptomatic UTI and always complete the course.
Therapeutic guidelines on diagnosis and treatment of urinary tract infections
- E. coli is the most common pathogen (20% to 50% of cases) but a wider range of bacteria can also cause infection.
- There is no clinical evidence to support the routine use of prophylactic antibiotics at the time of catheter change.
- All symptomatic cases should be investigated with a urine sample.
- The recommended duration of antimicrobial therapy is 7 days.
- In cases of catheter-associated urinary tract infection (CAUTI), where there is a delayed response to treatment, 10 to 14 days of therapy may be required.
- Do not screen for, or treat, asymptomatic bacteriuria in people who are catheterised.
- If the catheter has been in place for longer than 2 weeks when antimicrobial therapy is started, changing to a new catheter is recommended.
QSCIS acknowledges the Urology Department, Princess Alexandra Hospital for their assistance with developing this webpage.