Infection Prevention Manager Shirley Ryan Ability Lab Chicago, Illinois, United States
Objectives: To assess attributes of spinal cord injuries (SCI) associated with symptoms of intermittent catheter-associated urinary tract infections (ICP-UTIs) among patients in inpatient rehabilitation facilities (IRFs).
Design: Retrospective observational study of 381 adults admitted to an IRF with SCIs and developed ICP-UTIs between 2018 to 2023. Patients’ level of SCI, American Spinal Injury Association (ASIA) score, and type of injury (traumatic or nontraumatic) were collected from electronic medical records (EMR). ICP-UTI was defined as intermittent catheterization within 48 hours before a urinary culture with greater than 100,000 Colony-Forming Units of bacteria and documentation of symptoms: fever, dysuria, urgency, frequency, suprapubic tenderness (ST), and costovertebral angle tenderness (CVAT). Chi-squared analysis identified the statistical significance of ICP-UTI and frequency of reported symptoms stratified by ASIA Score and type of injury.
Results: Most traumatic SCI patients had an ASIA-A score (n=118, 31%). Most admitted ICP-UTI patients were admitted due to traumatic SCI (n=292, 76.6%), with a majority having cervical (n=170, 44.6%) or thoracic (n=115, 30.2%) level of injury. When patients were stratified by type of injury, we observed a significantly higher occurrence of fever than expected (p< 0.001) in traumatic SCI patients. Additionally, we observed a significantly higher occurrence of dysuria, urgency, and frequency than expected (p< 0.05) in non-traumatic SCI patients. It was notable that patients with ASIA-A scores, who lack intact sensation and bladder function, had documentation of dysuria (n=6), urgency (n=3), frequency (n=16), ST (n=4), and CVAT (n=1).The frequency of dysuria and urgency was significantly lower than expected (p< 0.05) among ASIA-A patients compared to the combined ASIA-B/C/D group.
Conclusions: ASIA Score and type of SCI may be factors that influence the type and frequency of reported ICP-UTI symptoms. Understanding these relationships is important to ensure accurate diagnosis of ICP-UTI among SCI patients in IRFs and improve patient safety related to intermittent catheterization.
