Clinical Data of Urine Culture and Antimicrobial Sensitivity Tests according to the Voiding Method over 15 Years in Patients with Spinal Cord Injury

Won Jun Lee; Sang Jin Kim; Jae Hyun Ryu; Yun Beom Kim; Seung Ok Yangy; Jeong Ki Lee; Tae Young Jung

doi:10.14777/uti.2016.11.1.30

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Lee, Kim, Ryu, Kim, Yangy, Lee, and Jung: Clinical Data of Urine Culture and Antimicrobial Sensitivity Tests according to the Voiding Method over 15 Years in Patients with Spinal Cord Injury

Original Article

Urogenit Tract Infect 2016;11(1):30-35.

Published online: 20 April 2016

DOI: https://doi.org/10.14777/uti.2016.11.1.30

Clinical Data of Urine Culture and Antimicrobial Sensitivity Tests according to the Voiding Method over 15 Years in Patients with Spinal Cord Injury

Won Jun Lee, Sang Jin Kim, Jae Hyun Ryu, Yun Beom Kim, Seung Ok Yangy, Jeong Ki Lee, Tae Young Jung

Department of Urology, Veterans Health Service Medical Center, Seoul, Korea

Correspondence to: Tae Young Jung http://orcid.org/0000-0002-4634-3370 Department of Urology, Veterans Health Service Center, 53, Jinhwangdo-ro 61-gil, Gangdong-gu, Seoul 05368, Korea Tel: +82-2-2225-1739, Fax: +82-2-2225-4374 E-mail: urodoct@hotmail.com

Received 31 March 2016 Revised 11 April 2016 Accepted 18 April 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To analyze the results of urine cultures and antimicrobial sensitivity tests according to the voiding methods in patients with spinal cord injury (SCI) over a 15-year period.

Materials and Methods

A total of 1,579 urine culture samples, obtained from January 2000 to December 2014, for 73 SCI patients were analyzed according to the voiding method. We analyzed the following: positive urine culture rate, colony counts, isolated number of organism, major organisms, and antimicrobial sensitivity tests. The voiding methods were categorized into four methods: clean intermittent catheterization (CIC), suprapubic catheterization (SPC), urethral Foley catheter, and spontaneous voiding (SV).

Results

Among the 1,579 urine samples, 1,250 (79.2%) were positive. The CIC group showed the lowest rate of bacteriuria (p＜0.001), colony counts (p＜0.001), and polymicrobial infection (p＜0.001). Causative organisms were mostly gram-negative bacteria (86.7%). Pseudomonas aeruginosa (22.7%) was most common pathogen followed by Escherichia coli (22.3%), Klebsiella species (9.5%), Providencia species (4.4%), and Serratia marcescens (4.2%). Major pathogens and antimicrobial sensitivity tests were different according to the voiding method.

Conclusions

CIC is the best voiding method to reduce urinary tract infection (UTI) in SCI patients. To treat UTI in in SCI patients, empirical antibiotics can be chosen according to the voiding method based on the reference of our study prior to the availability of antimicrobial sensitivity results.

Keywords: Bacteriuria, Spinal cord injuries, Urinary tract infections

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Table 1.

Positive urine cultures according to voiding method

Voiding method	Sterile cultures	Positive cultures	Total	p-value^a)
Clean intermittent catheterization	146 (27.6)	383 (72.4)	529 (100)	＜0.001
Suprapubic catheterization	82 (14.8)	473 (85.2)	555 (100)
Urethral Foley catheter	64 (19.9)	258 (80.1)	322 (100)
Spontaneous voiding	37 (21.4)	136 (78.6)	173 (100)

Values are presented as number (%).

^a) Analyzed by chi-square test.

Table 2.

Colony counts of the positive urine cultures

Voiding method	Colony counts (CFU/ml)					p-value^a)
Voiding method	10³≤ ＜10⁴	10⁴≤ ＜10⁵	10⁵≤ ＜10⁶	≥10⁶	Total (%)	p-value^a)
Clean intermittent catheterization	2 (0.5)	32 (8.4)	182 (47.5)	167 (43.6)	383 (100)	＜0.001
Suprapubic catheterization	0	34 (7.2)	192 (40.6)	247 (52.2)	473 (100)
Urethral Foley catheter	0	25 (9.7)	118 (45.9)	115 (44.4)	258 (100)
Spontaneous voiding	0	6 (4.4)	58 (43.0)	72 (52.6)	136 (100)

Values are presented as number (%).

Values are presented as number (%). CFU: colony-forming units.

^a) Analyzed by chi-square test.

Table 3.

Isolates of urine cultures according to voiding method

Voiding method	Isolated number				p-value^a)
Voiding method	1	2	3	Total	p-value^a)
Clean intermittent catheterization	326 (85.1)	54 (14.1)	3 (0.8)	383 (100)	＜0.001
Suprapubic catheterization	284 (60.0)	186 (39.3)	3 (0.6)	473 (100)
Urethral Foley catheter	188 (72.9)	68 (26.4)	2 (0.8)	258 (100)
Spontaneous voiding	106 (77.9)	27 (19.9)	3 (2.2)	136 (100)

Values are presented as number (%).

^a) Analyzed by chi-square test.

Table 4.

Major causative organisms (top 1–10)

Causative organism	Voiding method				Total
Causative organism	CIC	SPC	UF	SV	Total
Pseudomonas aeruginosa	45 (10.2)	210 (31.6)	69 (20.9)	41 (24.3)	365 (22.7)
Escherichia coli	146 (33.0)	90 (13.5)	81 (24.5)	42 (24.9)	359 (22.3)
Klebsiella species	71 (16.0)	45 (6.8)	23 (7.0)	14 (8.3)	153 (9.5)
Streptococcus species	36 (8.1)	60 (9.0)	15 (4.5)	14 (8.3)	125 (7.8)
Providencia species	14 (3.2)	40 (6.0)	7 (2.1)	10 (5.9)	71 (4.4)
Serratia marcescens	21 (4.7)	27 (4.1)	15 (4.5)	4 (2.4)	67 (4.2)
Citrobacter species	25 (5.6)	23 (3.5)	11 (3.3)	5 (3.0)	64 (4.0)
Staphylococcus species	24 (5.4)	16 (2.4)	6 (1.8)	10 (5.9)	56 (3.5)
Staphylococcus species	24 (5.4)	16 (2.4)	6 (1.8)	10 (5.9)	56 (3.5)
Acinetobacter species	13 (2.9)	21 (3.2)	13 (3.9)	8 (4.7)	55 (3.4)
Morganella morganii	10 (2.3)	24 (3.7)	19 (5.8)	2 (1.2)	55 (3.4)
Proteus species	7 (1.6)	22 (3.3)	10 (3.0)	6 (3.6)	45 (2.8)

Values are presented as number (%).

CIC: clean intermittent catheterization, SPC: suprapubic catheterization, UF: urethral Foley catheter, SV: spontaneous voiding.

Table 5.

Results of antimicrobial sensitivity tests according to voiding method

Antibiotics	Voiding method
Antibiotics	CIC	SPC	UF	SV
Penicillin	51.4	66.4	36.6	21.9
Ampicillin	10.4	9.8	7.4	12.4
Augmentin	52.3	43.8	44.0	44.6
Cefazolin	46.5	33.5	35.5	41.3
Cefoxitin	61.8	58.3	55.1	60.5
Cefotetan	59.3	39.0	69.7	72.7
Cefuroxime	32.5	18.4	30.8	47.1
Ceftazidime	64.9	60.6	60.6	76.7
Ceftriaxone	47.8	32.9	43.2	49.0
Cefepime	82.7	71.0	64.8	75.6
Ofloxacin	65.1	53.4	92.9	75.0
Ciprofloxacin	37.2	41.1	35.5	36.7
Levofloxacin	43.9	33.9	32.4	32.3
Gentamicin	59.8	56.4	50.1	46.2
Tobramycin	64.4	54.6	61.1	51.9
Amikacin	89.5	76.3	76.1	74.2
Piperacillin	35.7	47.8	33.2	42.8
Piperacillin/tazobactam	76.9	66.5	61.1	81.3
Imipenem	94.9	92.5	78.2	94.8
Meropenem	95.0	92.3	76.0	95.7
Ertapenem	100	97.9	98.1	100
Teicoplanin	100	93.5	63.6	100
Vancomycin	100	96.8	69.2	100
Trimethoprim-sulfamethoxazole	50.6	44.0	43.9	43.0
Tetracycline	30.2	31.6	42.7	32.7

Values are presented as a percentage.

CIC: clean intermittent catheterization, SPC: suprapubic catheterization, UF: urethral Foley catheter, SV: spontaneous voiding.

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