title: Comparison of bacterial strains and antibiotic susceptibilities in urinary isolates of spinal cord injury patients from the community and hospital.
abstract: METHODS
  A one-year epidemiological survey.
  
  
  OBJECTIVE
  To compare bacterial strains and antimicrobial susceptibilities of urinary isolates from hospital and community spinal cord injury (SCI) patients.
  
  
  METHODS
  A specialized SCI unit in a freestanding rehabilitation hospital.
  
  
  METHODS
  From June 2012 through May 2013, urine cultures were obtained from all of the newly admitted patients. Bacterial strains and antimicrobial susceptibilities were compared between patients from community and hospital settings.
  
  
  RESULTS
  The proportion of Enterobacteriaceae in the total urinary isolates from hospital-dwelling patients was smaller than that from community-dwelling patients (66.0 vs. 85.5%, P<0.001), while the proportions of Pseudomonas, Acinetobacter and Enterococcus species were relatively larger (8.7%, 6.0% and 12.0% vs. 2.8%, 0.7% and 2.8%, respectively, P<0.05). The isolates from hospital-dwelling patients showed lower susceptibility to ampicillin, amoxicillin-clavulanic acid, trimethoprim-sulfamethoxazole and all generations of cephalosporin (P<0.05), and a higher prevalence of extended-spectrum beta-lactamase (ESBL)-producers (41.7 vs. 5.4%, P<0.001), compared with those from community-dwelling patients. The susceptibility rates to levofloxacin were lower than 50% in both community and hospital-dwelling patients.
  
  
  CONCLUSIONS
  Broader-spectrum antibiotics should be considered in treating nosocomial urinary tract infection (UTI) of SCI patients because of the relatively wide variety of organisms and higher frequency of antibiotic-resistant strains, including ESBL-producing Enterobacteriaceae in hospital-derived specimens. Furthermore, in areas with high prevalence of fluoroquinolone resistance, fluoroquinolones should be used with caution during empirical treatment for UTI in SCI patients.
authors: Department of Internal Medicine, National Rehabilitation Center, Seoul, Korea.
authors: S B
authors: SB
authors: Yoon
authors: Department of Spinal Cord Injury Rehabilitation, National Rehabilitation Center, Seoul, Korea.
authors: B S
authors: BS
authors: Lee
authors: Department of Internal Medicine, National Rehabilitation Center, Seoul, Korea.
authors: K D
authors: KD
authors: Lee
authors: Department of Rehabilitation, Soonchunhyang University Hospital, Seoul, Korea.
authors: S I
authors: SI
authors: Hwang
authors: Department of Spinal Cord Injury Rehabilitation, National Rehabilitation Center, Seoul, Korea.
authors: H J
authors: HJ
authors: Lee
authors: Department of Spinal Cord Injury Rehabilitation, National Rehabilitation Center, Seoul, Korea.
authors: Z A
authors: ZA
authors: Han
mesh_terms: D000150:Acinetobacter / Q000187:drug effects / Q000302:isolation & purification; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001419:Bacteria / Q000187:drug effects* / Q000302:isolation & purification*; D024881:Drug Resistance, Bacterial; D004755:Enterobacteriaceae / Q000187:drug effects / Q000302:isolation & purification; D016983:Enterococcus / Q000187:drug effects / Q000302:isolation & purification; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010045:Outpatients; D011549:Pseudomonas / Q000187:drug effects / Q000302:isolation & purification; D013119:Spinal Cord Injuries / Q000382:microbiology* / Q000652:urine; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents