Prevention of urinary tract infection in patients with spinal cord injury

Background: Urinary tract infection (UTI) is a major cause of morbidity and mortality in individuals with spinal cord injury (SCI). Altered voiding dynamics, use of urinary drainage catheters, and frequent exposure to antibiotic agents predispose individuals with SCI to recurrent episodes of UTI, often with resistant organisms. Objective: To evaluate the efficacy of various methods of UTI prevention in the SCI population. These methods include type of bladder management, choice of catheter materials, antiseptic agents, oral antibiotics, and experimental approaches. Methods: Literature review. Findings: Choosing a method of bladder management that minimizes the use of a foreign body, yet drains the bladder effectively, is the best available means to reduce the risk of UTI. The chief drawback to antimicrobial-coated catheters, topical or intravesicular antiseptic agents, and prophylactic oral antibiotics is that, over time, bacteria become resistant and overcome the obstacles to bladder invasion. Therefore, antiinfective catheter materials, antibiotics, and antiseptic agents are not beneficial for long-term prevention of UTI in persons with SCI. Novel approaches that avoid the use of antimicrobial agents offer hope for patients with recurrent UTI, but these techniques are still in the experimental stage. Conclusions: Method of bladder management remains the most influential factor in reducing the risk of UTI in persons with SCI. Experimental approaches that inhibit adhesion and biofilm formation by uropathogens are promising.