Management of UTI

Why are people with SCI at higher risk of a UTI?

Urinary tract infections (UTIs) are a common secondary health condition following SCI and a major cause of morbidity in SCI. People with SCI are at increased risk due to altered bladder function and use of catheters. Complicated UTIs occur in people with anatomical or functional abnormalities such as neurogenic bladder, calculi or diabetes.

  • 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 and there are 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 aseptic technique.
  • Ensure that the flow of urine is unobstructed.
  • Suprapubic catheters are preferred for long-term use instead of urethral indwelling catheters.

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

  • Can be effectively used in the health care setting and home environments
  • Must be positive for both nitrates and leucocytes to indicate UTI

Culture/ Mid-Stream Urine (MSU)

  • Identify micro-organisms with a urine culture (MSU) to ensure the most appropriate antibiotic is prescribed.
  • Culture results should be taken with a newly inserted (sterile) catheter (both indwelling and intermittent).
  • One third of UTIs for people with SCI are polymicrobial.

What to do if a UTI 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 on 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 UTI’s

  • 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 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 with catheter-associated urinary tract infection (CAUTI) who have 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.
  • Change the catheter if it has been in for longer than 2 weeks when antimicrobial therapy is started.

Acknowledgements

QSCIS acknowledges the Urology Department, Princess Alexandra Hospital for assistance in updating and writing this information

References

Urinary tract infection (UTI) | Queensland Health

Cloudy urine, page 78
Reference: Geng, V., Lurvink, H., Pearce, I., Lauridsens, V. (2024) Best practice in urological heath care: Indwelling catheterisation in adults urethral and suprapubic. European Association of Urology Nurses

The other European guidelines for Neuro-urology also mention the cloudy urine

Hsieh JTC, McIntyre A, Loh E, Ethans K, Mehta S, Wolfe D, Teasell R. (2019). Epidemiology of Pediatric Spinal Cord Injury. In Eng JJ, Teasell RW, Miller WC, Wolfe DL, Townson AF, Hsieh JTC, Connolly SJ, Noonan VK, Loh E, Sproule S, McIntyre A, Querée M, editors. Spinal Cord Injury Rehabilitation Evidence. Version 7.0. Vancouver: p 1-274 bladder-management_final_v7-1.pdf

Therapeutic Guidelines (tg.org.au) Catheter-associated bacteriuria and urinary tract infection in adults Published April 2019