Prevention of Urinary Tract Infection in Persons with SCI

Urinary Tract Infection (UTI) is the most frequent medical complication during initial medical Rehabilitation after SCI, and continues to be a common cause of morbidity throughout life. It may produce only mild-to-moderate illness that can be managed on an outpatient basis, but it has also been reported as the leading cause of rehospitalization after SCI.

The diagnosis and treatment of UTI in persons with SCI may be delayed or missed after discharge because signs and symptoms are often subtle and primary care physicians, who are very familiar with diagnosis and treatment of UTI in populations without SCI, may not be trained in the diagnosis and treatment of UTI within the context of Neurogenic Bladder dysfunction and its various forms of management. It is important to understand the problems faced by persons with SCI in the management of UTI and to develop techniques that can reduce the frequency and severity of UTIs and thus reduce the need for rehospitalization.

The Northwest Regional SCI System is conducting a study to identify barriers to UTI prevention and to determine whether a UTI prevention educational program can reduce the frequency and severity of UTI. A minimum of 125 subjects is needed for this study. Participation for each subject involves a six-month baseline phase followed by a six-month experimental phase.

Baseline Phase: After an initial neurologic examination, each subject receives a renal (kidney) ultrasound exam and urine is collected for analysis and culture and sensitivity tests. Each subject will then be treated for any significant bacteriuria (bacteria in the urine) found in an initial urine sample. Subjects also complete 4 questionnaires and keep a 5-day voiding diary.

Thereafter, for a total of 6 months, urine is collected monthly from each subject for urinalysis and for culture and sensitivity, but subjects are asked to seek medical care from their usual providers for any possible urinary tract infections. Each month, subjects report the number of UTIs they experienced (if any) and the treatment received, as well as any UTI signs and symptoms. In addition, subjects are asked each month if their method of bladder management (i.e., urine elimination) has changed.

Experimental Phase: At the end of the baseline period, each subject is randomly assigned to either an experimental group or a control group. The experimental group receives an educational program on UTI prevention. The experimental and control groups both continue monthly urine monitoring for another 6 months. The study began in 1995 and concludes in the year 2000.

If you are interested in participating in this study, please call Eve Kelly at 206-548-4855. Study subjects must be 18 or older, be at least one year post-SCI, have had at least one UTI during the past year, and live within driving distance of Seattle. Those who complete the study will receive $100.

Fall 1997

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