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CC BY-NC-ND 4.0 · Revista Urología Colombiana / Colombian Urology Journal 2018; 27(01): 008-013
DOI: 10.1055/s-0038-1637014
Review Article | Artículo de Revisión
Sociedad Colombiana de Urología. Publicado por Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Infección Urinaria en Pacientes con Lesión Medular

Urinary Infection in Patients with Spinal Cord Lesion
Irma A. Ospina-Galeano
1   Servicio de Neurourología y Urología Funcional, Hospital Pablo Tobón Uribe, Medellín, Colombia
,
Albert Borau Duran
2   Servicio de Urología, Instituto Guttmann, Badalona, España
› Author Affiliations
Further Information

Publication History

28 February 2017

04 August 2017

Publication Date:
13 April 2018 (online)

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Resumen

La micción es un proceso complejo, que requiere la coordinación entre el sistema nervioso central y periférico. La alteración en ése, aumenta el riesgo para que se produzcan infecciones complicadas y a largo plazo, daño renal. La alteración en el vaciado de la vejiga, obliga a que muchos de esos pacientes, realicen cateterismos intermitentes o sonda vesical permanente, aumentando el riesgo de infecciones polimicrobianas o por gérmenes multiresistentes. Algunos factores implicados en el desarrollo de las infecciones de esos pacientes, son el residuo postmiccional elevado, estasis urinario, litiasis vesical, uso de catéteres, además de las alteraciones en el sistema inmune y las capas de recubrimiento en la mucosa vesical. El diagnóstico de infección se realiza al encontrar: piuria y bacteriuria, según método de vaciado vesical, y un síntoma general que sugiera infección. Conclusión: Las infecciones urinarias en pacientes con lesión medular, deben ser tratadas de acuerdo a sensibilidades de la zona, siempre con la toma previa de un urocultivo y con un diagnóstico adecuado de infección urinaria, teniendo en cuenta las diferentes maniobras de evacuación de la vejiga. No están recomendados los tratamientos cortos ni el tratamiento de las bacteriurias asintomáticas. Una de las formas de prevenir las infecciones, está en evitar situaciones de riesgo como el estasis vesical, las presiones intravesicales elevadas y los vaciamientos incompletos. En la actualidad existen múltiples medicamentos para prevenir las infecciones urinarias, pero faltan estudios con evidencia de más peso y en pacientes con lesión medular, para que puedan ser recomendados.

Abstract

Urination is a complex process, requiring coordination between the central and peripheral nervous system. The alteration in this, increases the risk for complicated infections and long-term kidney damage. The alteration in the emptying of the bladder, causes many of these patients to perform intermittent catheterization or permanent bladder catheterization, increasing the risk of polymicrobial infections or multiresistant germs. Some factors involved in the development of infections of these patients are high postvoiding, urinary stasis, vesical lithiasis, use of catheters, as well as alterations in the immune system and the layers of lining in the bladder mucosa. The diagnosis of infection is made on finding: pyuria and bacteriuria, according to the method of bladder emptying, and a general symptom that suggests infection. Conclusion: Urinary tract infections in patients with spinal cord injury should be treated according to the sensitivity of the area, always with prior urine collection and an adequate diagnosis of urinary tract infection, taking into account the different maneuvers of bladder evacuation. Short treatments and treatment of asymptomatic bacteriuria are not recommended. One way to prevent infections is to avoid risky situations such as bladder stasis, elevated intravesical pressures and incomplete emptying. At the moment there are multiple drugs to prevent urinary tract infections, but there are no studies with evidence of heaviest weight and in patients with spinal cord injury, so that they can be recommended.

Palabras Clave

infección urinaria - lesión medular - bacteriuria asintomática - cateterismo intermitente - disfunción vesical - vejiga neurogénica

Keywords

urinary tract infections - spinal cord injury - asymptomatic bacteriuria - intermitent catheterization - bladder dysfunction - neurogenic bladder
 

  • Referencias

  • 1 McKibben MJ, Seed P, Ross SS, Borawski KM. Urinary Tract Infection and Neurogenic Bladder. Urol Clin North Am 2015; 42 (04) 527-536
    CrossrefPubMedGoogle Scholar
  • 2 Carvajal C, Pacheco C, Gómez-Rojo C, Calderón J, Cadavid C, Jaimes F. Clinical and demographic characteristics of patients with spinal cord injury Six years experience. Acta Med Colomb 2015; 40 (01) 45-50
    PubMedGoogle Scholar
  • 3 Esclarín De Ruz A, García Leoni E, Herruzo Cabrera R. ; DE RUZ AE. Epidemiology and risk factors for urinary tract infection in patients with spinal cord injury. J Urol 2000; 164 (04) 1285-1289
    CrossrefPubMedGoogle Scholar
  • 4 Goetz LL, Klausner AP. Strategies for prevention of urinary tract infections in neurogenic bladder dysfunction. Phys Med Rehabil Clin N Am 2014; 25 (03) 605-618 , viii
    CrossrefPubMedGoogle Scholar
  • 5 García Leoni ME, Esclarín De Ruz A. Management of urinary tract infection in patients with spinal cord injuries. Clin Microbiol Infect 2003; 9 (08) 780-785
    CrossrefPubMedGoogle Scholar
  • 6 Mukai S, Shigemura K, Nomi M. , et al. Retrospective study for risk factors for febrile UTI in spinal cord injury patients with routine concomitant intermittent catheterization in outpatient settings. Spinal Cord 2016; 54 (01) 69-72
    CrossrefPubMedGoogle Scholar
  • 7 Chaudhry R, Madden-Fuentes RJ, Ortiz TK. , et al. Inflammatory response to Escherichia coli urinary tract infection in the neurogenic bladder of the spinal cord injured host. J Urol 2014; 191 (05) 1454-1461
    CrossrefPubMedGoogle Scholar
  • 8 Jahromi MS, Mure A, Gomez CS. UTIs in patients with neurogenic bladder. Curr Urol Rep 2014; 15 (09) 433
    CrossrefPubMedGoogle Scholar
  • 9 Vasudeva P, Madersbacher H. Factors implicated in pathogenesis of urinary tract infections in neurogenic bladders: some revered, few forgotten, others ignored. Neurourol Urodyn 2014; 33 (01) 95-100
    CrossrefPubMedGoogle Scholar
  • 10 Cicione A, Cantiello F, Ucciero G. , et al. Intravesical treatment with highly-concentrated hyaluronic acid and chondroitin sulphate in patients with recurrent urinary tract infections: Results from a multicentre survey. Can Urol Assoc J 2014; 8 (9-10): E721-E727
    CrossrefPubMedGoogle Scholar
  • 11 Kershen RT, Azadzoi KM, Siroky MB. Blood flow, pressure and compliance in the male human bladder. J Urol 2002; 168 (01) 121-125
    CrossrefPubMedGoogle Scholar
  • 12 Nicolle LE. Urinary tract infections in special populations: diabetes, renal transplant, HIV infection, and spinal cord injury. Infect Dis Clin North Am 2014; 28 (01) 91-104
    CrossrefPubMedGoogle Scholar
  • 13 Kim B-R, Lim JH, Lee SA. , et al. The Relation between Postvoid Residual and Occurrence of Urinary Tract Infection after Stroke in Rehabilitation Unit. Ann Rehabil Med 2012; 36 (02) 248-253
    CrossrefPubMedGoogle Scholar
  • 14 Berry RE, Klumpp DJ, Schaeffer AJ. Urothelial cultures support intracellular bacterial community formation by uropathogenic Escherichia coli. Infect Immun 2009; 77 (07) 2762-2772
    CrossrefPubMedGoogle Scholar
  • 15 Leuck A-M, Wright D, Ellingson L, Kraemer L, Kuskowski MA, Johnson JR. Complications of Foley catheters--is infection the greatest risk?. J Urol 2012; 187 (05) 1662-1666
    CrossrefPubMedGoogle Scholar
  • 16 Nomura S, Ishido T, Teranishi J, Makiyama K. Long-term analysis of suprapubic cystostomy drainage in patients with neurogenic bladder. Urol Int 2000; 65 (04) 185-189
    CrossrefPubMedGoogle Scholar
  • 17 Consortium for Spinal Cord Medicine. Paralyzed Veterans of America. Bladder management for adults with spinal cord injury: a clinical practice guideline for health-care providers. Washington, DC: Consortium for Spinal Cord Medicine; 2006
    Google Scholar
  • 18 Çetinel B, Önal B, Can G, Talat Z, Erhan B, Gündüz B. Risk factors predicting upper urinary tract deterioration in patients with spinal cord injury: A retrospective study: Risk Factors for Upper Urinary Tract Deterioration. Neurourol Urodyn 2017; 36 (03) 653-658
    CrossrefPubMedGoogle Scholar
  • 19 Siroky MB. Pathogenesis of bacteriuria and infection in the spinal cord injured patient. Am J Med 2002; 113 (1, Suppl 1A) 67S-79S
    CrossrefPubMedGoogle Scholar
  • 20 Mitsui T, Minami K, Furuno T, Morita H, Koyanagi T. Is suprapubic cystostomy an optimal urinary management in high quadriplegics? A comparative study of suprapubic cystostomy and clean intermittent catheterization. Eur Urol 2000; 38 (04) 434-438
    CrossrefPubMedGoogle Scholar
  • 21 Hunter KF, Bharmal A, Moore KN. Long-term bladder drainage: Suprapubic catheter versus other methods: a scoping review. Neurourol Urodyn 2013; 32 (07) 944-951
    CrossrefPubMedGoogle Scholar
  • 22 Hooton TM, Bradley SF, Cardenas DD. , et al; Infectious Diseases Society of America. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis 2010; 50 (05) 625-663
    CrossrefPubMedGoogle Scholar
  • 23 James D. The prevention and management of Urinary Tract Infection among people with spinal cord injuries. Disabil Rehabil Res 1992; 1: 5-36
    PubMedGoogle Scholar
  • 24 Ferroni M, Taylor AK. Asymptomatic Bacteriuria in Noncatheterized Adults. Urol Clin North Am 2015; 42 (04) 537-545
    CrossrefPubMedGoogle Scholar
  • 25 Massa LM, Hoffman JM, Cardenas DD. Validity, accuracy, and predictive value of urinary tract infection signs and symptoms in individuals with spinal cord injury on intermittent catheterization. J Spinal Cord Med 2009; 32 (05) 568-573
    CrossrefPubMedGoogle Scholar
  • 26 Linsenmeyer TA, Oakley A. Accuracy of individuals with spinal cord injury at predicting urinary tract infections based on their symptoms. J Spinal Cord Med 2003; 26 (04) 352-357
    CrossrefPubMedGoogle Scholar
  • 27 Cameron AP, Rodriguez GM, Schomer KG. Systematic review of urological followup after spinal cord injury. J Urol 2012; 187 (02) 391-397
    CrossrefPubMedGoogle Scholar
  • 28 Posible complications of urinary incontinence in people with neurological disease. National Institute for Health and Care Excellence. 2015: 2–7
    PubMedGoogle Scholar
  • 29 Boyle DP, Zembower TR. Epidemiology and Management of Emerging Drug-Resistant Gram-Negative Bacteria: Extended-Spectrum β-Lactamases and Beyond. Urol Clin North Am 2015; 42 (04) 493-505
    CrossrefPubMedGoogle Scholar
  • 30 Nicolle LE. Urinary tract infections in patients with spinal injuries. Curr Infect Dis Rep 2014; 16 (01) 390-399
    CrossrefPubMedGoogle Scholar
  • 31 Yoon SB, Lee BS, Lee KD, Hwang SI, Lee HJ, Han ZA. Comparison of bacterial strains and antibiotic susceptibilities in urinary isolates of spinal cord injury patients from the community and hospital. Spinal Cord 2014; 52 (04) 298-301
    CrossrefPubMedGoogle Scholar
  • 32 Dinh A, Toumi A, Blanc C. , et al. Management of febrile urinary tract infection among spinal cord injured patients. BMC Infect Dis 2016; 16 (01) 156-162
    CrossrefPubMedGoogle Scholar
  • 33 Hudson E, Murahata RI. The ‘no-touch’ method of intermittent urinary catheter insertion: can it reduce the risk of bacteria entering the bladder?. Spinal Cord 2005; 43 (10) 611-614
    CrossrefPubMedGoogle Scholar
  • 34 Fasugba O, Koerner J, Mitchell BG, Gardner A. Systematic review and meta-analysis of the effectiveness of antiseptic agents for meatal cleaning in the prevention of catheter-associated urinary tract infections. J Hosp Infect 2017; 95 (03) 233-242
    CrossrefPubMedGoogle Scholar
  • 35 Cardenas DD, Moore KN, Dannels-McClure A. , et al. Intermittent catheterization with a hydrophilic-coated catheter delays urinary tract infections in acute spinal cord injury: a prospective, randomized, multicenter trial. PM R 2011; 3 (05) 408-417
    CrossrefPubMedGoogle Scholar
  • 36 Bermingham SL, Hodgkinson S, Wright S, Hayter E, Spinks J, Pellowe C. Intermittent self catheterisation with hydrophilic, gel reservoir, and non-coated catheters: a systematic review and cost effectiveness analysis. BMJ 2013; 346 (15) e8639
    CrossrefPubMedGoogle Scholar
  • 37 Stensballe J, Looms D, Nielsen PN, Tvede M. Hydrophilic-coated catheters for intermittent catheterisation reduce urethral micro trauma: a prospective, randomised, participant-blinded, crossover study of three different types of catheters. Eur Urol 2005; 48 (06) 978-983
    CrossrefPubMedGoogle Scholar
  • 38 Pickard R, Lam T, MacLennan G. , et al. Antimicrobial catheters for reduction of symptomatic urinary tract infection in adults requiring short-term catheterisation in hospital: a multicentre randomised controlled trial. Lancet 2012; 380 (9857): 1927-1935
    CrossrefPubMedGoogle Scholar
  • 39 Salameh A, Al Mohajer M, Daroucihe RO. Prevention of urinary tract infections in patients with spinal cord injury. CMAJ 2015; 187 (11) 807-811
    CrossrefPubMedGoogle Scholar
  • 40 Feifer A, Corcos J. Contemporary role of suprapubic cystostomy in treatment of neuropathic bladder dysfunction in spinal cord injured patients. Neurourol Urodyn 2008; 27 (06) 475-479
    CrossrefPubMedGoogle Scholar
  • 41 Sorokin I, De E. Options for independent bladder management in patients with spinal cord injury and hand function prohibiting intermittent catheterization. Neurourol Urodyn 2015; 34 (02) 167-176
    CrossrefPubMedGoogle Scholar
  • 42 Katsumi HK, Kalisvaart JF, Ronningen LD, Hovey RM. Urethral versus suprapubic catheter: choosing the best bladder management for male spinal cord injury patients with indwelling catheters. Spinal Cord 2010; 48 (04) 325-329
    CrossrefPubMedGoogle Scholar
  • 43 Freire GdeC, Williams G, Craig JC. Cranberries for preventing urinary tract infections. Sao Paulo Med J 2013; 131 (05) 363
    CrossrefPubMedGoogle Scholar
  • 44 Berger RE. Cranberries for preventing urinary tract infections. J Urol 2005; 173 (06) 1988
    PubMedGoogle Scholar
  • 45 Darouiche RO, Green BG, Donovan WH. , et al. Multicenter randomized controlled trial of bacterial interference for prevention of urinary tract infection in patients with neurogenic bladder. Urology 2011; 78 (02) 341-346
    CrossrefPubMedGoogle Scholar
  • 46 Darouiche RO, Hull RA. Bacterial interference for prevention of urinary tract infection. Clin Infect Dis 2012; 55 (10) 1400-1407
    CrossrefPubMedGoogle Scholar
  • 47 Beerepoot MAJ, ter Riet G, Nys S. , et al. Lactobacilli vs antibiotics to prevent urinary tract infections: a randomized, double-blind, noninferiority trial in postmenopausal women. Arch Intern Med 2012; 172 (09) 704-712
    CrossrefPubMedGoogle Scholar
  • 48 Lee BB, Toh S-L, Ryan S. , et al. Probiotics [LGG-BB12 or RC14-GR1] versus placebo as prophylaxis for urinary tract infection in persons with spinal cord injury [ProSCIUTTU]: a study protocol for a randomised controlled trial. BMC Urol 2016; 16: 18-26
    CrossrefPubMedGoogle Scholar
  • 49 Damiano R, Quarto G, Bava I. , et al. Prevention of recurrent urinary tract infections by intravesical administration of hyaluronic acid and chondroitin sulphate: a placebo-controlled randomised trial. Eur Urol 2011; 59 (04) 645-651
    CrossrefPubMedGoogle Scholar
  • 50 Blok B, Pannek J, Diaz DC, del Popolo G, Groen J, Gross T. . Neuro-urology. 2015; Available from: http://uroweb.org/wp-content/uploads/21-Neuro-Urology_LR2.pdf
    PubMed