Diagnostic criteria of urinary tract infection in male patients with spinal cord injury.
BACKGROUND
The current diagnostic criteria of urinary tract infection (UTI) in male patients with spinal cord injury (SCI) are not clear.


METHODS
The authors studied 381 episodes of "symptomatic" UTI (209 participants) and 277 episodes of "asymptomatic" UTI (205 participants) in male SCI patients using intermittent catheterization. UTI was defined as a bacterial count ≥10(2) colony-forming units (cfu)/mL (American Paraplegia Society criterion). Univariate analysis and receiver operating characteristic (ROC) curve analysis were used to determine optimal cfu and white blood cell (WBC) thresholds.


RESULTS
The most prevalent clinical signs, alone or in combination, were cloudy and/or malodorous urine (51.4%), onset of urinary incontinence (51.2%), fatigue (41.7%), fever (30.7%), and increased spasticity (30.2%). Urine cfu and WBC levels in patients with only one sign, including fever, were not significantly higher than those in asymptomatic controls. WBC, but not cfu, levels increased significantly with the number of signs (P = .026). Univariate analysis and ROC curve analysis failed to identify cfu, WBC, or a combination of cfu and WBC count thresholds, allowing discrimination between the symptomatic and asymptomatic UTI groups.


CONCLUSIONS
Clinical signs of UTI correlate poorly with the urine cfu and WBC levels in SCI patients, except for a positive relationship between WBC counts and the number of signs. Fever alone has no higher diagnostic value. There are no satisfactory cfu and WBC thresholds: thresholds more restrictive than the current American Paraplegia Society criteria provide higher specificity values but with equivalent loss of sensitivity.
Hôpital Raymond Poincaré, Assistance Publique-Hôpitaux de Paris, Garches, France.
Esthel
E
Ronco
Pierre
P
Denys
Claire
C
Bernède-Bauduin
Isabelle
I
Laffont
Patricia
P
Martel
Jérôme
J
Salomon
Bernard
B
Bussel
Didier
D
Guillemot
Jean-Louis
JL
Gaillard
D000328:Adult; D003937:Diagnosis, Differential; D006801:Humans; D007958:Leukocyte Count / Q000379:methods; D008297:Male; D008875:Middle Aged; D013119:Spinal Cord Injuries / Q000150:complications*; D013234:Stem Cells / Q000382:microbiology; D014552:Urinary Tract Infections / Q000150:complications / Q000175:diagnosis*; D055815:Young Adult